Considering autistic patients in the era of telemedicine: the need for an adaptable, equitable, and compassionate approach

Abstract

Introduction The COVID-19 pandemic has accelerated the widespread adoption of remote consultations in general practice in the UK; using telephones, video, or e-consults accompanied by a reduction in routine face-to-face consultations. These approaches allow for continued healthcare provision while reducing the risk of transmission of communicable infections. Telephone consultations have already been a staple within general practice for many years, despite a lack of high quality evidence supporting their use.1 Reported benefits include convenience for patients and cost savings.2 However, patients tend to disclose fewer medical issues on telephone calls than in face-to-face consultations.3 Similarly, video calls rely on high quality internet and patient ability to operate the required technology.4 Autism is a neurodevelopmental condition encompassing differences in social interaction, communication, and sensory perception.5 Differences occur in the use of verbal and non-verbal communication. Challenges can include situational mutism or reliance on augmentative and alternative communication (AAC) devices for individuals who are non-speaking. Autism is not synonymous with learning disability. In fact, the majority of autistic adults do not have a learning disability.6 Autism diagnoses have a prevalence of at least 1%,7 but autism is likely much more prevalent due to underrecognition and under-diagnosis.7 As such, autistic individuals are a patient group all primary care professionalsare likely to encounter on a regular or semi-regular basis. Autistic adults face increased barriers to accessing health care,5 and have higher mortality rates than the general population.5 Considering the needs of autistic patients in accessing primary health care is therefore vital if we are to embody the ethical tenets of beneficence and social justice. We write this article as neurodivergent doctors. SS is autistic and dyslexic. He is a GP speciality trainee with a parallel academic career. He has researched and published widely around the topic of neurodiversity, with particular interests in dyslexia, dyspraxia, and autism. He is currently the research lead for Autistic Doctors International. LJD is also a GP speciality trainee, with a background in academic research and public health. She is dyspraxic and has a specialist interest in supporting neurodivergent patients. MD is an autistic consultant anaesthetist and is the founder of Autistic Doctors International. Using a combination of the wider literature and our own experiences, both as clinicians and as patients, we explore the potential strengths and limitations of telemedicine in the context of autistic patients. We also propose some suggestions for increasing its accessibility.