Conditions Ill-Suited to Telemedicine

Telehealth has become an integral part of the Australian healthcare system since the COVID-19 pandemic. However, while virtual doctor’s consultations can be convenient and efficient for many patients requiring non-urgent care, they are not always the best choice. Knowing when calling an online doctor is not your go-to can make the difference between receiving the right healthcare at the right time or risking worsening your condition.

The limitations of telehealth are clearly described by the Australian Medical Board’s guidelines for practitioners [1]. They mainly stem from the absence of physical assessments and an inability to monitor patients continuously and escalate treatment quickly in emergencies. You will find that most telehealth providers screen for these at the beginning of their booking process. Often, there is a pop-up or questionnaire asking you whether you are experiencing any of the below:

• Severe Symptoms and Emergencies: If you have certain symptoms, including chest pain, severe shortness of breath, sudden severe headaches, or persistent vomiting, you need immediate medical attention in a clinical setting. Symptoms like these indicate emergencies. You should call 000 or have someone take you to your nearest A&E immediately.
• Physical Assessments: Certain conditions require physical assessment using imaging, tests, or a physician seeing or palpating the affected area. This could be suspected fractures, severe abdominal pain, or unexplained lumps. Sometimes, a telehealth provider will ask you to attend your closest diagnostic centre or head to a health practitioner close to you, if you are too far from major medical centres or hospitals.
• Neurological Concerns: Symptoms like confusion, weakness, or numbness often require immediate physical assessment to rule out serious conditions. This is not limited to new symptoms, but also to worsening ones.
• Significant Injuries: Severe injuries or suspected fractures, such as a broken arm, demand swift, hands-on evaluation and treatment, something telemedicine can't provide. If you or your family member have had a fall or other sudden trauma to the body, it is best to see a doctor in person immediately.
• Severe Bleeding: Heavy bleeding can have serious consequences, whether that’s from an injury, due to an illness, or other health reasons. Telehealth is inadequate for managing bleeding that is severe and unmanageable. Such conditions require urgent in-person medical care to prevent further complications. You may need to have assistance beyond stemming the blood loss, for example in the form of blood transfusions, ongoing monitoring or iron infusions.
• Hands-On Procedures: Conditions requiring treatments such as injections or physiotherapy often cannot be adequately addressed by telehealth. They may necessitate direct contact, physical assessment, and specialised equipment not available in remote consultations.
• Complex Mental Health Needs: While telehealth helps bring faster access to mental health consultations and assessments with GPs or other doctors, this is not always sufficient. If you are feeling suicidal or are suffering from acute psychiatric disorders in-person engagement and interdisciplinary teamwork is required to ensure comprehensive care and effective treatment plans.

There are several ways in which telehealth providers can work around some of the limitations of physical assessments. For example, some doctors may use a patient’s home health equipment, like blood pressure monitors or glucometers, to get more information about their patient’s needs.

Where available, they may ask the patient to have an available nurse or other health care worker, such as in an NDIS setting, to perform physical assessments. This may help them fill in some of the missing information and assess a patient more fully.

Nevertheless, it is important to recognize when these measures fall short. A sign of a good telehealth provider is that they tell you when they cannot assist you and ask you to either attend an in-person consultation head to your nearest A&E.

Ultimately, whether you need a physical or virtual doctor’s consultation comes down to the nature and severity of your medical condition. Telemedicine offers much greater convenience and accessibility, but immediate physical assessments and treatments require a face-to-face consultation. It is crucial you provide any telehealth service you intend to use with a clear and full picture of your condition and needs at the time of booking. This allows for a faster transfer back to an in-person consultation, if necessary.

This article is for informational purposes only and is no substitute for professional medical advice. Please choose your provider with care. Always consult your doctor or a qualified health professional regarding any health-related questions or concerns.

[1] https://www.medicalboard.gov.au/Codes-Guidelines-Policies/Telehealth-consultations-with-patients.aspx