Patients are at risk of being under-diagnosed by GPs during consultations over the phone or online, a new study has found

Researchers said mistakes via remote consultations are rare – but there is a risk GPs could miss serious conditions or that doctors are swayed by what has been said previously. They also pointed at less qualified staff not acting on signs of illness.

In one case, a woman in her 70s experiencing sudden breathlessness was told by a GP receptionist she would be called back.

This never happened as the receptionist became distracted by a patient in the waiting room. The telephone patient deteriorated and died at home that afternoon.

The study, published in BMJ Quality and Safety, looked at data from 95 UK safety incidents between 2020 and 2023, such as complaints, settled compensation claims and reports.

It found some of the errors made related to serious conditions – like congenital heart disease, pulmonary oedema, sepsis, cancer and diabetic foot complications – “which would likely have been readily diagnosed with an in-person examination”.

The researchers added: “Several safety incidents involved clinicians assuming that a diagnosis made on a remote consultation was definitive rather than provisional.

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“Especially when subsequent consultations were remote, such errors could become ingrained, leading to diagnostic over-shadowing and missed or delayed diagnosis.”

Misdiagnosis

In another case, NHS 111 staff failed to diagnose a pregnant woman with premature rupture of membranes and instead she was taken down a “urinary problems algorithm”.

Elsewhere, a 16-year-old girl also died of sepsis after a GP spoke to her older sister on the phone and mistakenly diagnosed glandular fever.

Other cases involved missed pulmonary embolism in a new mother leading to her death and missed congenital heart disease in a baby.

In some cases, GPs themselves realised the limitations of remote consultations.

One doctor said: “I’ve remembered one father that called up. Really didn’t seem to be too concerned.

“And was very much under-playing it and then when I did a video call, you know this child… had intercostal recession… looked really, really poorly. And it was quite scary actually that, you know, you’d had the conversation and if you’d just listened to what dad was saying, actually, you probably wouldn’t be concerned.”

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The study found that patients with pre-existing conditions – especially if they had several or they were worsening – and the very young and the elderly “were particularly difficult to assess by telephone”.

Researchers said: “Clinical conditions difficult to assess remotely included possible cardiac pain, acute abdomen, breathing difficulties, vague and generalised symptoms and symptoms which progressed despite treatment.”

Researchers found that GP surgeries were suffering due to understaffing and high demand.

The study’s findings come after Sky News analysis of NHS data found one in every five GP practices in England and Wales has closed since 2013.

The study recommended clinicians ensure the patient knows what the next steps are in their care, while patients should make clear if they are deteriorating.

Dr Rebecca Rosen, study author from the Nuffield Trust, said: “Remote consulting is here to stay and the study has identified ways in which to ensure quality and safety.

“Every clinician must be aware of high-risk symptoms for which it’s safer to see patients face to face; must listen and respond carefully to patients who say they need an in-person appointment and should consult face-to-face if a patient has not improved after previous remote consultations.

“We can also ensure that patients have the knowledge and tools to help them to get the best out of their consultations.”

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