Our survey of plastic surgeons shows that the use of virtual consultations has been accelerated by COVID-19 lockdown with majority suggesting that they will continue to have a role alongside traditional face-to-face consultations in the future. However, as with any new technology, further guidance is required to ascertain the following: which platforms can be legally used, is communication sufficient to consent and discharge patients and which situations still require face-to-face consultations.
Only 32.7% of doctors were using purpose-built platforms, with the majority opting for commercial platforms such as Zoom, Skype and, Facetime. Purpose-built platforms ensure adequate encryption to prevent any unwanted intrusion of confidential information and are compliant with UK and EU digital information law6,8. During the pandemic, emergency legislation and organisational guidelines were relaxed to allow platforms to be used to facilitate patient care. However, we anticipate future guidance to allow VCons over purpose-built platforms only to ensure safety and security of both doctor and patient. 41.5% of doctors in our survey were unaware of their indemnity status whilst utilising VCons. Currently, the UK General Medical Council (GMC) has not provided specific advice regarding indemnity cover for VCons. However doctors are required to have adequate indemnity in place for all areas of their practice 9.
Adequate communication during VCons is essential for a plastic surgeon in order to inform and obtain adequate consent prior to later procedures. History-taking and interviewing patients is a key skill that surgeons develop at medical school and refine during their entire career, however, during VCons verbal and non-verbal communication can be limited by technical and logistical constraints. Certain platforms can compress video making facial expressions difficult to read and hindering non-verbal communication, in telephone consultations non-verbal communication is lost entirely. Video-based consultations may also suffer from lag resulting in audio and video becoming unsynchronised10. However, other studies have shown that the presence of lag lead to better communication as the delay forced participants to consider their words with more thought and make greater use of turn-taking11. For procedures with fewer risks to communicate, VCons may be sufficient to consent and discharge, however, as our survey showed, the majority of surgeons (53.7%) would still prefer a face-to-face consultation before undertaking a procedure particularly those which are more invasive. Based on our survey, we decided to formulate a checklist in order to aid clinicians in selecting a platform suitable for VCons (Table 1).
Lengthier and more invasive procedures have more risks to communicate to the patient, the surgeon has a duty when consenting to make sure the patient can understand, retain and, weigh up the information given to them during consultation. Currently, there are no laws or guidelines describing comprehensively which procedures can be consented to virtually and which procedures require a patient to be seen in person. 58.5% of doctors we surveyed state that they believe VCons can be used instead of face to face for some treatments but not all, however, the decision is currently at the surgeon’s discretion. Examining a patient remotely can be problematic, 68.3% of our survey did not carry out remote examinations and only 7.3% made constant use of chaperones. Some describe tasking their patients to self-assess pre-operation such as for lymphadenopathy in lieu of a conventional examination, however, lack of examiner skill may mask any significant pathology12.