key: cord-0688684-6gfhm750
authors: Cheng, Ching‐Siang
title: Consultant‐delivered care in telehealth and phone consultations during the COVID‐19 shutdown period
date: 2020-07-20
journal: ANZ J Surg
DOI: 10.1111/ans.16172
sha: a87e3aa6a2147c249d244a45bde2eb6f7302cbaa
doc_id: 688684
cord_uid: 6gfhm750

nan

I congratulate Timm et al. 1 for receiving reports of patient satisfaction with Doctor-in-Training-delivered consultations in telehealth published in a recent issue. From our recent experience at the Cairns Hospital Vascular Surgical Outpatient Clinics, telehealth and phone consultations became the mainstay of reviewing patients during the coronavirus disease 2019 (COVID-19) shutdown period. Being a regional centre, our patients from the indigenous communities were also in complete lockdown. Our catchment involves a wide geographical area.

I am aware that this situation is mirrored elsewhere in Australia, with the full potential of telehealth yet to be completely tapped. My opinion is that any doctor-in-training delivered model, in recent times, should revert to a consultant-delivered model, which is usually our standard of care. Studies have shown that consultantdelivered clinics get improved outcomes for patient care 2 or are at least more time efficient. 3 Back at our clinic during the COVID-19 shutdown period, I would routinely triage the patients into several categories by determining the suitability of registrars and junior doctors in taking on the phone or telehealth review. We worked at our usual outpatient clinics in adjacent rooms, and I was available to participate in any ongoing consult. The workflow was as such:

(1) Junior doctor appropriatesuch as follow-up of stable patients with surveillance scans, with the consultant reviewing the past history and prior scans.

(2) Registrar appropriatesuch as post-operative follow-up with clear plan already laid out prior by the consultant, or less complex new referrals. (3) Consultant preferredfollow-up of complex cases and complex patients with multiple issues and complex decisionmaking

While it is important that doctor-in-training learning is not neglected, 4 best patient care remains imperative. The categories suggested should be modified according to the experience level of the doctors present, thus affording the needed training.

We still need the clinic; patient perceptions on doctor-in-training delivered telehealth versus in-person consultation

Front door surgeons: the rise of consultant-delivered acute surgical care

What is the impact of consultant supervision on outpatient follow-up rate?

Views, behaviours and perceived staff development needs of doctors and surgeons regarding learners in outpatient clinics