Medical consultations by phone to become permanent, despite GPs’ hesitancy

The medical consultations by phone or video call that became commonplace during the pandemic are here to stay – at least for now, according to Belgium’s health minister Frank Vandenbroucke.

Permission to conduct teleconsultations has been extended as of 1 August, reports RTBF.  But it’s not intended to make the method a first-choice for citizens, Vandenbroucke announced.

“Let's be clear: the aim is not for video consultation to become the norm and replace the traditional consultation,” said Vandenbroucke. 

“The clinical examination is of course an essential part of making a diagnosis.”

Most Belgian patients are expected to welcome the news: three out of four survey respondents said they were “satisfied” or “very satisfied” with teleconsultations during the pandemic. 

Respondents to the survey, which was carried out during the summer of 2020 among 5,000 members, said they appreciated the communication with their family doctor (GP) and their willingness to take the time to listen to them.

But GPs are considerably less enthusiastic. Dr Thomas Orban of the GBO (Groupement Belge des Omnipraticiens), the medical union for French-speaking general practitioners, said he considers it to be an outsourcing of medicine.

“One of my patients called me the day before yesterday by telephone, saying that he has a urinary infection and that I should send him a prescription for an antibiotic via his identity card. Basically, send me the treatment, thanks and bye,” Orban said.

“My secretary tells him that it’s a consultation and that he has to come to the practice to be examined. He replies that he doesn't have time. We refused. I am not a consumable good!”

Patients are supposed to pay €1 or €2 out of their pocket for teleconsultations, but practitioners say this isn’t enforceable. 

“Few patients asked us after a telephone consultation how much they owed us,” said Orban. “You can imagine, asking them to make a payment before starting – it's unworkable, doctors probably won't ask for it.”

The result for doctors is that they earn just half as much as they did before, when allowing for all costs.

Orban said that GPs have been on the frontline of the pandemic for two years and counting. He considered that the government was breaking a bond of trust with the green light for teleconsultations simply the most recent example.

He explained that a teleconsultation had medical and legal responsibility, not to mention consequences. Expecting a doctor to bear that for less than €10 shows “contempt for our work”.

Another issue was work-life balance for GPs, who said that they’re increasingly overwhelmed by texts, emails, video calls and WhatsApp notifications from patients who are bombarding them through all possible channels of communication. It’s something they accepted during the pandemic but are now beginning to feel pressured by.

Orban said it’s time to put the emphasis back on the consultation where a doctor can examine and talk to the patient face to face.

“Teleconsultations are a good solution for the patient,” he said, “but we should really put some guidelines in place.”

Some of the guidelines stemming from the extension to the practise, include that a remote consultation will only be reimbursed by insurance if it’s between a patient and a doctor known to them (or with a specialist to whom another doctor has referred them). It must also be requested by the patient and agreed to by the doctor; the doctor must have access to the patient's file during the consultation; and the platform used for a video consultation must be secure.