Intended for healthcare professionals

Practice 10-Minute Consultation

Covid-19: a remote assessment in primary care

BMJ 2020; 368 doi: https://doi.org/10.1136/bmj.m1182 (Published 25 March 2020) Cite this as: BMJ 2020;368:m1182

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  1. Trisha Greenhalgh, professor of primary care health sciences1,
  2. Gerald Choon Huat Koh, professor of public health and family medicine2,
  3. Josip Car, director, reader in primary care and e-health3 4
  1. 1Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK
  2. 2Saw Swee Hock School of Public Health, Yong Loo Lin School of Medicine, National University of Singapore
  3. 3Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
  4. 4Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
  1. Correspondence to: T Greenhalgh trish.greenhalgh{at}phc.ox.ac.uk

What you need to know

  • Most patients with covid-19 can be managed remotely with advice on symptomatic management and self isolation

  • Although such consultations can be done by telephone in many cases, video provides additional visual cues and therapeutic presence

  • Breathlessness is a concerning symptom, though there is currently no validated tool for assessing it remotely

  • Safety-netting advice is crucial because some patients deteriorate in week 2, most commonly with pneumonia

A 37 year-old healthcare assistant develops a cough. Next day, she wakes with a fever (which she measures at 37.4°C) and shortness of breath. She manages her condition at home for several days, experiencing increasing tiredness, loss of appetite, and a persistent dry cough. On the fifth day of her illness, she develops mild diarrhoea, and her chest feels quite tight. She takes her temperature, which has gone up to 38.1°C. Feeling unwell, she contacts her GP surgery for advice. She would like someone to listen to her chest, but the receptionist tells her not to come to the surgery and offers her the choice of a telephone or video consultation. She was previously well apart from mild asthma (on occasional salbutamol). Five years ago, she took citalopram for anxiety. She is a single parent of three children.

Novel coronavirus disease 2019 (covid-19) is an urgent and spreading threat whose clinical and epidemiological characteristics are still being documented.12 With a view to containing covid-19, a shift from in-person to remote consulting is occurring. Clinicians are thus faced with a new disease and a new way of interacting with patients.

This article will present some guiding principles on how to choose between telephone and video appointments, how to conduct a “query covid” consultation remotely, and considerations when arranging follow-up and next steps. It does not cover remote triage or how to set up …

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