Patients are 'dying from remote GP consultations' …major study warns.

A headline from the Daily Mail, plus several others.

It is entirely misleading.

You have to wonder why and how the 21 academics involved have allowed their work to be so horribly distorted and not realise the damage it does to public confidence.

This is the actual report and what the egg-heads actually said, buried in the discussion section;

‘An important overall finding from this study is that examples of deaths or serious harms associated with remote encounters in primary care were extremely rare… amounting to fewer than 100 despite an extensive search going back several years.’

If I may just add some context…

… every year in England 237 million medication errors occur… 21% are … prescribing … and 38% are in primary care.

With something like 30m consultations with GPs every month, it’s inevitable things will go wrong.

The Health Foundation in an analysis in 2011 found… around 1-2% of consultations featured an adverse event… and most adverse events did not cause harm to patients.

They reported the underlying causes of medical errors… 

• human factors,
• in particular communication,
• structural processes such as reporting systems,
• and clinical factors such as [diagnostic and] medication errors. 

Within the clinical factors group, diagnostic error was the largest proportion (≈61%) followed by medication errors (≈26%) and delayed referrals (≈11%).

If you wanted to make a headline out of that, you might end up with;

‘GPs are killing us with wrong diagnosis, poisoning us with the wrong drugs and letting us die, waiting.’

There is no place for complacency in medicine. No justification for getting things wrong, not learning-and-fixing but maintaining a sense of maturity would seem not to be a bad idea? 

It’s important not to feed the ‘blame culture’ that is such a toxic feature of working in the NHS.

What does the ‘remote consultation study’ actually say? You can read it here.

In brief;

The study followed 12 GP practices and I quote exactly [from the paragraph, Methods: study design and origins];

‘… from mid-2021 to the end 2023… ‘

The exact words.

You may realise we are not yet at the end of 2023 due to the inconvenient, incontrovertible truth that this is November. So what we are supposed to make of that?

To the end of the year, to the end of the study... 'till the 21 got bored?

Dunno.

The study-set consisted of 95 reports collected either over 18 months or longer, depending on whatever ‘2023’ means. 

Garnered from… 

… complaints to NHSE between 2020 and 2023… what does that mean? Two years or three? 

… complaints to NHS Resolution between 2015 and 2023… err, outside the parameters? And, by the time a complaint reaches NHSR, it could be three, maybe five years old. Does it matter?

… reports from an urgent care telephone service in Wales, presumably not a GP practice and…

…a report on an investigation of telephone advice during the COVID-19 crisis between 2020 and 2022… hardly typical of GP traffic?

Hands-up… I’m no academic but I thought one of the basics was to compare apples with apples. This is apples with lightbulbs and lightbulbs with cannon-balls… isn’t it?

There are 15 cases of harm featured in the report. Systematically fictionalised from the 59… chosen on what basis? 

Dunno.

Top-line; 

• human factors,
• in particular communication,
• structural processes such as reporting systems,
• and clinical factors such as [diagnostic and] medication errors…

... familiar? Yes! Just like the Health Foundation 2011 report… proving what? You don’t need a telephone to make a mistake? 

Additionally, there were stories of racism, inability to use the internet and a patient with a heart attack who didn’t want to visit the surgery.

It’s impossible for a numpty like me to make any sense of this. If it really is 'academic' I feel lucky to have escaped.

In innocent ignorance I ask what value is this ‘research’ over and above what we know…

... primary care is very busy, the phone doesn’t suit everyone, training is and always will be important, getting a history right is vital…

... just as it would be in face-to-face consultations.

It certainly does not support the implication of the headline; patients are dying from remote GP consultations.

Blame the newspaper? No. Universities have communication departments and professionals to handle this stuff.

Importantly it asks questions about how research is brought into the public domain and onto the breakfast table of the great unwashed, such as me. 

Do academics have a responsibility for framing the narrative and shaping society's understanding?

If the only objective is 'get cited' and ‘grab a headline at any price' they risk getting lost in fake news and post-truth.