Follow-up from home after care in London

What remote follow-up can cover

Remote follow-up is a planned conversation with the doctor who saw you in London, by telephone or video, once you are home. It suits going through results that arrive after you fly, answering the questions that come up at home, reviewing how a new medicine is working, and checking on a long-term condition between visits.

It works best when it is planned before you leave. Agree with the doctor which results are still to come, when you will speak, and what would bring the call forward.

What the evidence shows

For many follow-up tasks, care at a distance appears to work about as well as care in person. A Cochrane review of 93 randomised trials with 22,047 participants compared interactive telemedicine, given alongside or instead of usual care, with usual care alone [1]. In heart failure it found no difference in deaths, people with diabetes followed remotely had slightly lower HbA1c, and in the trials of therapy for mental health problems, video worked as well as meeting face to face [1].

These trials studied particular conditions and services, many of them monitoring a long-term condition, so they describe what remote care can do in good conditions and cannot predict every case. Care by telephone alone was outside the review [1].

Where remote follow-up has limits

A doctor at a distance cannot examine you. Principles agreed by UK healthcare regulators ask professionals working remotely to make an adequate clinical assessment, and to check important information by examination or testing where necessary [2]. When a symptom needs hands-on examination, a scan or a blood test, the doctor arranges it near you or asks you to be seen in person.

Prescribing has its own limits. The same principles say a professional can prescribe only when it is safe, and that it is unsafe without enough information about your health or when remote care does not suit your needs [2].

The country you are in matters as well. Before consulting remotely with patients overseas, UK professionals are expected to check whether they must register with a regulator where the patient is and where any medicine would be dispensed, and to take account of local restrictions on particular medicines [2]. Rules differ widely between countries, so a doctor in London may be able to talk through your results and still need a local doctor to examine you or write a prescription.

How to make remote follow-up work

A little preparation makes a short call worth a great deal. The CDC advises anyone treated abroad to take copies of their records home and give them to every doctor who sees them afterwards [3].

• Agree before you leave which results are still to come and who will go through them with you
• Give the clinic a telephone number that works abroad, and the time zone you will be in
• Keep a list of your medicines and any change since London, with doses
• Measure what the doctor asks for, such as blood pressure or weight, and note each reading with its date
• Choose a quiet, private place with a steady connection for a video call
• Know the name of a local doctor who can examine you if the call shows you need it

Keeping your doctor at home informed

Follow-up is safer when everyone involved in your care has the same information. The regulators’ principles ask professionals to arrange aftercare and, unless the patient objects, to share relevant information with others involved in their care [2].

Information about your health is special category data under UK data protection law, and it may be used only when extra conditions are met [4]. In practice that means your letters and results go to your doctor at home with your agreement, by a secure route.

Who it suits and who it does not

It suits you if your care in London is complete or settled, and what remains is talking through results or adjusting the plan for a condition that is stable. It also suits people who travel often and want one doctor who knows their history wherever they are.

It is the wrong route for a new or worsening symptom that needs examination, and for anything urgent. If you have chest pain, sudden breathlessness, signs of a stroke or severe bleeding, call the local emergency number, or 999 in the UK [5].

How The Wellness can help

A telephone consultation is £59, fifteen minutes with a doctor the same day. Members reach their doctor by phone or video from any country, and when they need to be seen in person abroad we find a trusted local doctor or clinic and send the record ahead, with the visit itself paid at our partner rates [6].

Every result and letter goes into one record you open from any country, and a doctor anywhere can read it [5]. Every doctor is GMC registered, and beyond London appointments can be arranged with partners in 12 more cities.