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Late 2019 saw the beginnings of the pandemic we now know as COVID-19. WHO estimates that over 5.5 million people have died worldwide, and there has been an estimated loss of global economic output to the tune of 2.96 trillion US dollars according to Statista. These are unprecedented numbers – yet they are just statistics, and do not tell the stories of the individuals or services impacted during these times. Against such stark and alarming figures, I am writing this blog post to highlight a potential positive outcome: how patient experience and privacy has improved during the pandemic.
During my tenure at the Infectious Diseases department in the Royal Victoria Infirmary, Newcastle, I was part of a project that looked to research patient experiences of telephone consultation. We thought that it was important to assess the rapid switch to these types of consultation as a part of our service evaluation to see where we could improve. We found that both patient and staff experiences of remote consultation were generally positive.
We developed a survey to collect patient and staff views through a mixture of short answer, yes/no and rating scale questions. There were a total of 61 patient responses and 18 staff responses. A question which asked respondents to rate their experience of clinics revealed promising findings, with more than 90% of both clinicians and patients being either ‘very satisfied’ or ‘satisfied’ with the service being offered or provided. The results from the rating scale gave us usable data in identifying what physiological measurements were possible at home. For example, 75% of patients could measure their own waistline, 23% could measure their blood pressure at home and over 80% could talk via telephone in a confidential location.
The qualitative findings from our study shone through, adding complexity to the picture. One patient said: “I’m a nurse… Telephone appointments allow me to stay at work and ensure I am free at the time of the appointment to discuss things in confidence”. However, another patient noted feeling “limited to what I can say on the phone, due to confidentiality”. One patient was concerned about the confidentiality of face-to-face visits: “Confidentiality of the visit as the appointment is at the sexual health clinic, embarrassment… Would prefer the clinic wasn't held at the sexual health clinic. Can another place be found?”. Another patient said: “I am profoundly deaf and lip read. I rely on my husband to relay the questions. I answer the direct questions myself but there is always the temptation of the Relay Assistant to provide an answer without asking or not relaying the full information provided, not intentionally, just that you are not in control of the conversation.”
It’s clear that the first of these patients had a positive experience. They can take their phone call at work, within a confidential area. However, the second patient did not have such a positive experience. Some patients do not have a space within their homes or workplace where they can take a phone call, and this may limit their confidentiality in remote appointments. We must also take note that while to healthcare professionals a sexual health clinic may be just a convenient location for a confidential health meeting, patients may be concerned about being seen there by passers-by who know them.
Our work shows the value of having different options for clinics and the importance of giving patients autonomy to decide between telephone or face-to-face appointments where possible. This ensures that patients who do not have a confidential space to take a phone call are able to attend appointments face-to-face, and offers patients more choices in terms of how we communicate with them – for example, the patient noted above who relies on lip reading can specify the need to meet in person.
We do note that we have not yet had an experience in our records of someone who has needed to utilise a translator in order to communicate. However, during a staff meeting towards the end of the project, we highlighted the need for guidelines around how to use these valuable professionals in telephone calls, and the importance of ensuring we knew the languages and dialects of our patients.
We can do the best for our patients by creating structures within the system to offer both telephone and face-to-face clinics from the outset. If we allow patients to decide what is the most appropriate communication method, we may just find that they will choose what is right for them. This is the path to a more flexible NHS that will provide the right service at the right time.
Thanks to Sarah Walpole, Jo Glen-Davison, Andrea Armstrong, the RVI Patient Experience Team and Adam Evans who collaborated on the study and to Catherine Meyfroidt, Christine Nixon and Fiona Jerry who helped to contact patients for the study. Thank you to Ewan Hunter and Brendan Payne for commenting on previous drafts of this text and to the RVI Infectious Disease Team.