Re: Working remotely: a perspective on telemedicine in delivery of obstetrics and gynaecology health care

Abstract

Dear Editor, We read with interest the article on telemedicine in obstetrics and gynaecology. Following this, we were inspired to undertake a patient satisfaction survey with virtual appointments within our gynaecology clinics. In line with the NHS vision for ‘digitally enabled’ health care, virtual clinics were introduced rapidly during the COVID-19 pandemic. In July 2020, ‘remote first’ became a long-term government policy with plans for a future high proportion of virtual appointments. Although Trusts were given the video platform ‘attend anywhere’, most remote consultations have been and remain by telephone. We note that in UK gynaecology units, the uptake of video consultations is lower compared with other specialties. Video appointments present the additional benefit of allowing patients to see their clinicians and aids rapport building through nonverbal communication, simulating ‘face-to-face’ interaction. We audited against the ‘Getting It Right First Time (GIRFT)’ standard that 25% of all gynaecological consultations should be virtual and found that in our unit, the percentage of virtual consultations was 18.3%. A total of 80 service users were asked about satisfaction with their phone appointment held between October and December 2021, in a variety of gynaecology clinics in an ethnically diverse, busy, inner London teaching hospital, using a questionnaire based on published validated surveys. Of the women questioned, 76% were from a Black, Asian and Minority Ethnic (BAME) background. Using a Likert scale from 1–5, most (87.5%) ‘strongly agreed’ or ‘agreed’ that they felt comfortable communicating about their condition over the telephone, 79% felt that their doctor understood their concern and 71.2% felt that their healthcare needs were addressed. Whilst these values of satisfaction appeared high, only 50% scored a ‘4’ or a ‘5’ when asked if they were happy with their management and about satisfaction with their consultation. Less than half (41%) would want to use the service again. Bhalla et al.’s call to provide an evidence-base in telemedicine is essential amidst widespread implementation of telephone consultations within NHS gynaecology services. We question if telephone appointments should be given to all women by default and if more consideration should be given to video consultations. Our unit’s population comes from one of the most deprived London boroughs, and such patients from lower socioeconomic backgrounds and ethnic minority groups are at higher risk of health inequalities, particularly from remote consultations. Further inquiry into the factors to explain the mismatch between our patients’ expectations and care received could potentially reduce the health inequality gap with remote consultations, in keeping with a previously published notion “if virtual gynaecology clinics are here to stay, we need to include everyone”.