The rush to embrace telemedicine and other forms of digital healthcare tools occurred as a result of demand and necessity. However, the move away from in-person care to a more remote, automated approach is not without its drawbacks and has implications on health professionals meeting their duty ethically and under law.
The implication for patients dealing with the harmful outcomes of substance abuse poses a particular risk in a digital triage context. Here’s the lowdown on what can be missed, and why it matters.
In the case of digital triage leading to subpar clinical outcomes, like identifying substance-related harm through a remote patient assessment, the healthcare professional involved, depending on the laws and regulations in the country in question (like the NHS in the UK), could face grave legal exposure grounded in negligence, breach of duty of care, and potential regulatory action.
Failure to meet the same standards of care as during in-person consultations, which is expected of healthcare professionals, will not only have harmful effects on the patient (like an avoidable overdose) and resulting legal liability for the doctor or nurse. Reasonable diligence must be taken to extract relevant details from the patient and notice any red flags. In this day and age, with AI’s proliferation, over-reliance on this type of algorithmic technology, taking shortcuts for what requires careful clinical oversight, can compound all of this legal liability. How would any of this actually arise in reality? Let’s dig into the challenges.
The challenges of remote assessment
A person in the midst of a substance harm-related crisis might not present symptoms in a way that’s obvious to a remote assessor. Being confused or agitated might thus be dismissed as associated with other, preexisting conditions, rather than acute health issues requiring immediate intervention.
Likewise, there are physical aspects that an in-person exam would make obvious that simply don’t come across on a laptop or tablet screen. Pupil dilation, excessively sweaty or dry skin, and behavioural ticks like breathing and swallowing outside of normal parameters can end up overlooked.
Then, there’s the higher likelihood of patients playing down or failing to disclose symptoms of substance abuse because of the associated stigma. Clinicians might have to take them at their word if only diagnosing them remotely, while digital systems driven by diagnostic algorithms have even less to go on if an end user is not wholly honest.
Additional risks
First and foremost, an imperfect digital triage that does not spot the signs of substance harm will delay access to treatment. In the case that a drug user requires the support of a ketamine detox clinic to safely reduce their reliance on this substance, a remote assessment might not pick up on the telltale signs of a problem with this substance, including urinary discomfort and increased anxiety. In-person assessment remains the most effective option for determining next steps.
Tech savviness also comes into play when digital health tools get prioritised. People who are less familiar with using modern devices, or do not have access to them in the first place, along with a suitable network connection, may be incapable of using digital triage platforms.
Lastly, there’s the potential for people who are at most significant risk to be the ones who are also most likely to slip through the cracks in the move to remote assessment. Experts argue that the lack of a rigorous safety net means that anyone whose needs are most urgent is likely to be overlooked.
Making progress
While digital triage does pose the risk of missing substance harm signs, improvements are taking place at the moment. The integration of AI and the enhanced analytical capabilities it brings can improve assessment accuracy and outcomes, for example, even in remote contexts.
Similarly, as practitioners gain a clearer understanding of how best to use telehealth tools, and as training programs provide a structured approach to learning to harness them, the human element of this equation is becoming less of a weak point.
There’s certainly a place for digital triage and remote assessment, especially if it alleviates pressure on already strained in-person resources. It’s just having an awareness of the imperfections involved that must also be perpetuated and acted upon.
Photo licensed from Canva by Big Pond Digital Ltd.
