What cannot be treated with telemedicine?

Being able to talk to a doctor from your hotel room changes what it means to fall ill abroad. But a service is only genuinely useful if it is straight about where it stops, and telemedicine has real limits that matter most at exactly the moment you are least able to weigh them up.

Knowing what a video consultation cannot do is what makes it safe to use for the things it can. This article sets out the three kinds of problem that need in-person care, and then the grey area in between, where a call is still the right first move.

• Signs of a heart attack. Chest pain that feels like crushing or squeezing, which may spread to your arm, neck or jaw, with shortness of breath, nausea or sweating.
• Signs of a stroke. One side of the face drooping, not being able to lift both arms, or slurred and confused speech. Get help even if the signs have stopped.
• Severe difficulty breathing. Gasping for air, unable to speak in full sentences, or lips and skin turning pale, blue or grey.
• Uncontrolled bleeding or major trauma. Deep cuts that will not stop bleeding, serious burns, or a significant fall or accident.
• Loss of consciousness, or a big change in mental state. Fainting, a seizure, or sudden severe confusion, disorientation or agitation.

A good habit on arriving anywhere: look up the local emergency number and save it. Across the European Union you can call 112 free of charge from a landline or a mobile, and it works in some countries outside the EU too. In Australia it is 000, and in the United States 911.

Why do some conditions need in-person care?

It helps to know why a call is the wrong tool, rather than just which conditions are on the list. The limits fall into three groups.

1. Emergencies. Where the problem is time and the treatment is physical.
2. The hands-on examination. Where a doctor needs to press, feel, or look inside something with an instrument.
3. Tests and procedures. Where the answer lives in a lab or an X-ray, or the treatment is something done to you.

Symptoms that need a physical examination

A doctor's hands and instruments are diagnostic tools. A camera is a good one for some things and no substitute at all for others.

Severe abdominal pain

To work out what is causing it, a doctor needs to press on the abdomen, a technique called palpation, checking for tenderness, rigidity and specific points of pain. That is how conditions like appendicitis and bowel obstruction get caught, and none of it can be done down a lens.

Ear pain that needs the ear examined

Plenty of earache can be talked through by video: the NHS notes that most ear infections clear up within 3 days, and a doctor can ask questions that narrow down the cause and advise on pain relief and what to watch for. The honest limit is that a camera cannot see the eardrum: a GP or pharmacist may look into the ear with an otoscope, and a video call cannot. Earache that has not improved after 3 days, or comes with fluid from the ear, swelling around it or a change in hearing, needs to be seen in person.

New neurological symptoms

Numbness, tingling, dizziness or muscle weakness, particularly if it is new or getting worse, needs a physical examination: reflexes, balance, strength and sensation, tested rather than described.

Eye injuries and anything in the eye

Examining the surface of an eye for a scratch, an embedded foreign body or the early signs of infection takes specialised lights and magnification. This is one where a photograph genuinely will not do.

Conditions that need tests or procedures

A video consultation is a consultation. It cannot run a test or carry out a treatment.

Suspected broken bones and joint injuries

A suspected fracture or a serious ligament tear needs an X-ray or another form of imaging. There is no version of this that happens on a phone.

Cuts that may need stitches

Closing a wound is a physical procedure. A doctor may be able to look and tell you whether it is likely to need closing, which is useful, but the closing itself happens in a clinic.

Anything confirmed by a lab

A doctor may strongly suspect strep throat or a urinary tract infection, but confirming either can need a swab or a sample. There is more on where that lands in our guide to antibiotics and video consultations.

Vaccinations and injections

A tetanus booster after a deep cut, or rabies treatment after an animal bite, has to be given by someone in the room with you.

The grey area, where a call is still the right first step

Here is the part the list above does not capture. You often cannot tell which category you are in. Is this abdominal pain severe, or is it a bad reaction to an unfamiliar meal? Is this cut deep enough to need stitches? That uncertainty is the normal state of being unwell somewhere unfamiliar.

This is exactly where a video consultation earns its place. A doctor can ask the questions that sort urgent from uncomfortable, and can tell you which door to walk through: a pharmacy, a walk-in clinic, or an emergency department. That can save you a frightening and unnecessary trip to a hospital in a city you do not know, and it can also get you there faster when you should be going.

A consultation that ends with be seen in person is a success. You have swapped a guess for a plan. Video or in person compares the two routes side by side.

Knowing which level of care you need

Pomodoc connects you with an English-speaking doctor licensed to treat you in the country you are in. For a lot of travel health problems that consultation is the whole answer, and five common travel illnesses a video doctor can help with covers those.

For the rest, the value is the direction. Working out what level of care a symptom needs, in a language you speak, is a genuinely hard thing to do alone in an unfamiliar country, and it is most of what goes wrong when people either sit on something serious or spend a day in an emergency department they did not need.

If the level you need turns out to be a walk-in clinic, video doctor or walk-in clinic sets out what going to one abroad involves, and what to have ready before you speak to a doctor applies either way.

In short

• Emergencies go straight to hospital. Chest pain, stroke signs, severe breathing difficulty, heavy bleeding, loss of consciousness.
• Some things need hands. Severe abdominal pain, ear pain that needs the eardrum seen, new neurological symptoms, eye injuries.
• Some things need a lab or a procedure. Suspected fractures, stitches, swabs and samples, vaccinations.
• In doubt, call anyway. Sorting urgent from uncomfortable is something a doctor can do quickly and you cannot.
• Be seen in person is a result. It means you now know where to go and why.