• adolescent health
• child abuse
• child psychiatry
• ethics

The High Court recently provided what appear to be the first judicial comments on remote consultations. These resonate with these two papers.1 2 The case3 concerned whether Mental Health Act 1983 (MHA) applications for assessment and treatment required face-to-face interview and examination. The court concluded that the MHA requires physical attendance of the practitioner on the patient. Although this decision is applicable only to clinical practice in England and Wales, the allure of virtual consultation will be felt throughout a world enduring a pandemic.

While the case was primarily concerned with mental illness, the management of which is highly prescribed in ways unfamiliar to doctors looking after the physical health of children, it nonetheless touched on the limitations of remote consultations applicable to us all. The notion of being unable to discern non-verbal cues such as the smell associated with poor hygiene, or to assess proprioception, or to notice tremor or the scars of self-harm was brought out in the judgement. More far-reaching concerns such as establishing the identity of the ostensible child patient, and the presence and influence of an adult in the same room of whom the doctor is oblivious, were not touched on, …