Remote Consulting Flashcards
What are remote consultations?
Remote consultations are any form of consultation where the patient and clinician are not in the same room
What are the methods for remote consultations?
This includes synchronous methods, such as consultations by telephone or video-call, and asynchronous methods such as electronic consultations using online forms, email and text messaging.
What model did General Practice move towards at the start of the pandemic?
General Practice in the UK moved to a 100% ‘Total Triage’ model of care which means that all patients requesting an appointment in primary care were triaged first, with subsequent mode of assessment and management decided on the patient’s need.
Why was Total Triage necessary?
necessary to reduce infection risk to patients and healthcare professionals and so patients were only seen face-to-face where absolutely necessary.
What did the 2019 NHS Long Term Plan set out requirements for?
The NHS Long Term Plan (2019) set out requirements that all patients will have the right to online consultations by April 2020 and video consultations by April 2021. The overall aim is that all patients have a right to ‘digital first primary care’ by 2023/24, meaning that all patients could access their GP first using online
Examples of patients’ needs where telephone consultation would be used?
- Discussion of abnormal blood and imaging results.
- Proactive care planning e.g. frail elderly patients
- Request for fit notes
- Mental health reviews
- Management of patients with chronic conditions (asthma, diabetes, COPD, mental health conditions) that need med reviews or symptom management
- Triage of patients with acute problems e.g. sore throat, headache, back pain that may require signposting to other services e.g. pharmacy
Why might you choose video consultations?
- Patient prefers to see a clinician’s face.
- You need to eye-ball the patient to look at a rash or tonsils or assess a patient’s work of breathing.
- The consultation sounds ‘higher risk’ or ‘more serious’ on a telephone call.
- The patient is anxious. There is a more ‘therapeutic presence’ with video, and therefore potentially a more effective consultation.
What are the potential advantages of remote (telephone, video or online) consultations over traditional face-to-face consultations?
- Convenience and time-efficiency -> patients can send in online forms any time and receive a response same or next day. Also receive calls in comfort of home
- Access to clinical care -> every only form is reviewed on daily basis so no long queues which is better for less mobile or disabled patients
- Reduce barriers in communication -> some patients find who find face-face communication hard e.g. deaf or learning difficulties may find asynchronous communication better as they can take the time to construct the message
- Better use of clinician time and flexibility to allocate resource more effectively -> they can spend more time dealing with a patients complex issues
- Reduced stress and time-pressure due to flexibility of working
What are the potential disadvantages of remote consulting?
- Convenience -> patient may not be available all day to take confidential call
- Not appropriate for all clinical problems and/or key clinical information may be missed -> e.g. examinations or looking at gait or patient’s appearance
- Technology unavailable or difficult to use -> can widen healthy inequity e.g. patients who are elderly, homeless, hard of hearing etc.
- Misunderstanding or perceived misunderstandings more likely over remote consultations -> in face-face consultations, use of non-verbal cues can improve doctor patient understanding
- Reduced ability for opportunistic health screening -> e.g. BP/weight
- Intrusion -> some patients may not want doctor to see home surroundings
- less formal or professional
- Confidentiality issues -> text could be read by not intended recipient
- Safety concerns -> patients may send online forms for problems that should have been dealt with immediately
- Increased workloads
- Increased difficulty getting hold of patients in response to telephone or online request
- Potential reduction in ability to pick up safeguarding concerns
When are face-to-face appointments more appropriate than remote consultations?
- If an examination is necessary e.g. acute abdominal pain, gynaecological assessment or breast lump
- If further assessment that cannot be obtained by telephone/ video (e.g oxygen saturations or PEFR) is required in patients suspected of being seriously unwell (e.g. acute asthma, sepsis, suspected COVID-19 infection).
- If patients cannot or does not have the technology or capacity to participate e.g. dementia, learning disabilities, homelessness, some mental health problems.
- Some hard of hearing patients may find it difficult to participate (video may be better than phone for lip reading or use of chat function).
- Elderly frail patients with multiple morbidities and polypharmacy are best assessed face-to-face.
Why do remote consultations make communication difficult?
- Remote consultations (phone, video and online) make communication much more challenging because the usual non-verbal cues that facilitate communication and rapport-building are absent e.g. facial expressions, hand gestures and body language.
- Verbal communication can also be more difficult if there is background noise, time delays over video, language barriers or for patients that are hard of hearing or have dysphasia.
Examples where doctor-patient interaction itself is the therapeutic intervention?
- anticipatory care planning for patients and their families at the end of their life
- bereaved patients
- breaking bad news e.g. new diagnosis of cancer or chronic condition with life-long impact
- patients with mental health illness e.g. depression when risk assessment is necessary or anxiety
- patients that are lonely and isolated or having to shield during COVID-19 pandemic
What is presence?
Presence is a purposeful practice of awareness, focus, and attention with the intent to understand and connect with patients.
Describe the principles of Presence
Prepare with intention -> pause and refresh between virtual visits and familiarise yourself with patient
Listen intently and completely -> Nod, maintain eye contact and avoid interruptions
Agree on what matters most -> establish virtual visit agenda that incorporates patient priorities
Connect with patient’s story -> engage virtually with patient’s home environment
Explore emotional cues -> tune into facial expressions, body language and change in tone
How can you communicate the message of personal caring to a patient when the medium makes it difficult?
1) The medium -> telephone and video are better when emotions are concerned
2) Who makes the call -> continuity of care would be best as you know the patient best
3) No platitudes or cliches -> people won’t forget how you make them feel
4) Build rapport -> make it easier for patient to confide in you e.g. open questions (how is this affecting you, how are you feeling etc.) LISTENING IS IMPORTANT
