Telemedicine in the UK; what will it take to realise wide scale adoption?

We’ve been focusing very much on virtual primary care, predominantly in the private sector,” said Bayju Thakar of his organisation Synergix Health, which provides virtual consultations to over 250,000 people across more than 100 countries.

There were four key actors in the telemedicine space, he told delegates – doctors, patients, investors and non-incumbent startups. “With doctors, the question is how do you get them to engage and do things differently? I’m a doctor myself, and the interesting thing about going to medical school is that, right from the start, you’re taught that you’re special and more important than anyone else. This can create a veneer of hubris and resistance to change.”

Telemedicine was not just about “putting a doctor on Skype”, he stressed. “It’s incredibly complicated.” There were key issues around how behaviours needed to change in order to engender trust, carry out a competent clinical consultation and make a diagnosis, he said. The dropout rate for doctors taking his organisation’s training was 50% – 90% of whom were male. “Female trainees also tend to score more highly in the training. What we’ve found is that male doctors just tend to be more arrogant and resistant to change, whereas female GPs tend to be kinder and to like the work/life balance they get by working from home.”

This meant there was a real need for the emergence of female GP leaders in the telemedicine space, he told the seminar – “they’re the ones who are adopting this. We also need to be starting this at medical school and nursing school, and with first-year students, because at the moment you’re not taught anything about it.”

Patients, however, were the most important actors in the space. “But people don’t really want this until they’re sick – no one thinks, ‘I’ll engage in virtual primary care –that’ll be fun’.” Some telecommunications companies were good at engaging people in this, some not, he said. “But for patients to really adopt this at scale it will need to be fun and part of their wider digital engagement.”

When it came to investors, digital had the reputation of ultra-fast development, but this was not the case in healthcare, he pointed out. The right sort of investors were those who were in the healthcare space already and able to understand its infrastructure, culture and behaviours. They would also need “the right sort of long-play business model – where investors get it wrong, the capital flow dries up. So they need deep healthcare expertise, deep balance sheets and a long-term business model.”

Finally, with entrepreneurs, there was too much hyperbole in the start-up space, which could make things difficult, he said. “You’re always going to have evangelisers, and that can be great, but it can also make people distrustful. We as start-up entrepreneurs need to be a lot more honest about where we are, and where we want to be.”  

While there had been some media criticism about the cherry picking of patients for telemedicine, there were always going to be “perverse incentives in the health service, including in the NHS”, he said. “One East London borough had the highest level of DNAs [Did Not Attends] and introduced a system of sending text messages the night before and the morning of the appointment, which massively reduced the rate. The GPs shut it down.”

In terms of measuring quality, patients were able to give immediate feedback and consultations could be audited, he stated. “We study the doctors who are excellent, and we systemise that – ‘this is how we want our doctors to behave.’ The doctor/patient interaction is one of the few left in the western world where two strangers can come together and show kindness, compassion, vulnerability. I don’t want AI to obviate that.”