June 1, 2015
I was motivated to write this short piece by looking through the material for the Remote Consulting unit of the Telehealth and Telemedicine course for the Edinburgh MSc in Global eHealth.
Helen Atherton, an active researcher in email consulting, created a fascinating set of resources on the topic for the students of that course, which I co-organise with Brian McKinstry (i.e.: Brian provides the wisdom of (sometimes bitter) experience, I implement and add my two cents from a Human Computer Interaction point of view.).
One of the topics that came up was the use of Skype for remote consultation. Skype is a good alternative to traditional phone consultations because
- everybody can sign up for free
- in situations where you need video, it is easy to switch on
- it can be used by people who do not have a landline or access to a landline phone
- it can be used anywhere with WiFi access, which means that people do not have to use or pay for call minutes
But from my own experience, there are two important issues here that make me question whether Skype is suitable for video consultations.
1) Is Skype stable?
Not really, especially not if you use the video facility. I am typically online via fast Wifi at work courtesy of eduroam (yes, University of Edinburgh eduroam works well!), and I never have any trouble uploading or downloading big papers, large data sets, or Apple system updates. But when I’m asked to take part in a Skype meeting, I will never switch on video unless the other party insists, because that is a recipe for disaster.
I haven’t systematically kept track of the number of times a multi party Skype call failed because one of the people had switched on video, and worked well once the video had been switched off, but I’d guess this has happend in about half the Skype conferences (with video) that I have been involved in.
2) Is Skype safe?
I am not going to start discussing privacy features and whether conversations can be overheard by third parties here – that’s a whole other topic which is best discussed by somebody with expertise in the area.
What I mean is safety from unsavoury contacts. While my Skype handle is gender neutral (mkwolters), I have my full name associated with it, and my name is searchable, so that collaborators who wish to add me can easily find me on Skype. I also have a portrait photo with my own face, which clearly marks me as a female.
This means that every week or so, I get a contact request from a random account pretending to be a man. Half of these use an icon that would suggest that they are a member of the US Army, and are looking to talk to somebody while on active duty. The only time I was accosted by an account that pretended to be a woman, the person was recruiting for the web cam version of phone sex, which only became clear after a longer exchange. (I like to see what’s behind those scammers. I’m nosy like that.)
A good friend of mine (male) who has locked down his own Skype profile gets so many contact requests from women that he now refuses to leave his Skype open.
On one level, this is the Skype equivalent of the good old Nigerian scam or phishing email. On another level, I can see how this might make people highly uncomfortable. (It makes me extremely uncomfortable, and I’ve been on the Internet since 1994.)
It wasn’t always like that. Before the recent wave of scammers hit, I was on Skype for years with nary an incident. But the climate has changed, and I regard Skype as fundamentally unsafe.
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So, if I were a health care practitioner, offering telehealth consultations to older patients at home, would I be keen to introduce Skype video consulting?
Short answer: No.
Long answer: Not unless they already have a Skype account, are comfortable with using the service, are experts at fending off unwanted online attention, and have good experiences with one to one video calls.
I would not advise or expect older people to invest in Skype just to be able to access their health care from home – just as I wouldn’t advise them to spice up their social life by chatting to that nice man who has come by their door with an unbeatable offer for triple glazed windows.