Practical Tips for Performing Virtual Consultations
Advice from an experienced UK medic on how to approach and execute telehealth care for your patients
Dr. Elson Musenga is a primary care physician based out of the United Kingdom, incorporating telehealth and virtual consultations into his patient care flows. He was a member of the virtual care team within Operation Flow’s Hospital @ Home service in the NHS’s Lanarkshire regional trust, a virtual care program that led to large reductions in hospital bed occupancy levels and emergency departments wait times. Below, he outlines practical tips and resources for clinicians new to virtual care services to help provide the best care possible to patients through existing and evolving telehealth models.
NHS lanarkshire is the health board/ region rather than hospital. And Operation flow was a health board wide improvement programme — I was part of the virtual care component via the “Hospital @ Home” service
Virtual consultations have existed for decades but the COVID-19 pandemic is when we really began to see wide-spread adoption and renewed interest both from clinicians and patients. With this renewed interest, we are now starting to see the development and maturation of the evidence base for the use of these consultations versus more traditional face-to-face consultations.
I define virtual consultations as physician-patient clinical consultations conducted either by telephone or video conferencing. However, with the burgeoning use of virtual reality tech (such as metaverse), this definition will no doubt grow to encompass such modalities.
With that being said, there is a lot already to consider. If you’re keen to incorporate telehealth and virtual care into your toolbox, here are some thoughts coming from my experiences as a physician using telehealth for my patients.
Let’s dive in.
Question 1: How is performing telehealth consultations different from in-person consultations?
Question 2: What are some common stumbling blocks you see when clinicians first make this transition?
Question 3: What framework would you recommend for translating in-person care to virtual consultations?
Question 4: Which tools should clinicians be familiar with before getting started with telehealth?
Question 5: What are some resources that you found that have helped guide you along your journey?
Question 1: How is performing telehealth consultations different from in-person consultations?
The simple obvious answer to this is that one is face to face and the other is virtual. The key missing link with virtual consultations for many clinicians is what can be simply termed as the “end-of-the-bed” test: the hard-earned and well-honed ability of a clinician to walk into a room and determine how unwell a patient is simply by observing them or conducting rudimentary examination. This could include sounding a heart, palpating the abdomen, pr picking up all those subtle clues that may point towards underlying diagnosis. The other aspect to this is that it is often a lot easier to develop an empathetic therapeutic relationship with a patient when in-person because your communication is immediate and unfiltered. Nevertheless, there are many ways we can compensate for this as discussed later on.
Question 2: What are some common stumbling blocks you see when clinicians first make this transition?
The biggest pitfall that occurs when transitioning to virtual consultations is not adequately preparing yourself or your patient for this change. There is a risk of alienating your most vulnerable and disadvantaged patient groups who may not be equipped with the tools to fully engage with this mode of care. Important things to consider when first starting out can be categorised into patient factors vs physician factors.
Patient factors include: demography/patient population; patients’ beliefs and feelings about virtual consultation and patients’ capability or capacity for virtual consultation. Or, think of it this way: young, tech savvy patient groups vs socio-economically deprived groups. However, you shouldn’t assume that just because your patient is in the older age group that they are tech illiterate. Additionally, some patient groups may not have access to good internet connection or devices.
Physician factors include: type of service provided, location of consultations, and ability to follow up with face to face consultations. Some services as management of acutely unwell patients may not be suitable for virtual consultations for every patient. Your ability to provide treatment and prescribe may be limited in some circumstances. The UK general medical council state that
“…consider limitations of remote services when deciding the scope of practice and range of medicines prescribed. Some categories of medicines are not suitable to be prescribed remotely…”
Question 3: What framework would you recommend for translating in-person care to virtual consultations?
I recommend a three-step approach to carrying out virtual consultations.
The first step would be preparation. This will encompass preparing yourself, nailing the technical details, and preparing your patients. Ensure you are set up correctly with the right equipment (desktop with two screens), high quality video-audio and reliable internet connection. Ensure you maintain confidentiality, utilising a quiet and private space. Ensure your patient is well prepared by providing them with information prior to the consultation.
The second step would be how to correctly approach assessing a patient during a virtual consultation. Communication and body language is key. For video consultations, use visual cues such as colour, skin changes, swellings or appearance of the home environment. Patients may be able to provide high quality images for closer visual inspection. For telephone consultations, audio cues such as breathlessness or coughing may be helpful. Patients may also be able to provide readings from home monitoring devices such as blood pressure or oxygen saturation.
Finally, the third step is closing out the consultation. Does the patient require follow-up or would they be able to manage at home? I would always recommend that you have the ability to follow up with a face to face consultation as needed; for example, for severe illness or sensitive conversations such as breaking bad news.
Question 4: Which tools should clinicians be familiar with before getting started with telehealth?
Clinicians should be familiar with the local guidelines of whatever setting they find themselves working in. Clinicians wishing to conduct virtual consultations should also be family with virtual desktop infrastructure which would enable them to access their clinical applications and systems from home. For video conferencing there are a variety of platforms available. For example, NHS England uses “Attend Anywhere” which is a web-based platform that is integrated to existing NHS clinical and admin software and is widely available across the UK for use in settings such as primary care, outpatient clinics and care homes.
Question 5: What are some resources that you found that have helped guide you along your journey?
Enclosed below are a list of resources that would be helpful to any clinician embarking on virtual consultations. Note, many of these resources are best on UK health care but would be applicable to other settings.
Resources List:
General Medical Council: Guidance for remote consultations
British Medical Journal:
- Car J, Koh G C, Foong P S, Wang C J. Video consultations in primary and specialist care during the covid-19 pandemic and beyond BMJ 2020.
- Greenhalgh T, Koh G C H, Car J. Covid-19: a remote assessment in primary care BMJ 2020.
Royal College of General Practitioners: Top tips for GPs performing video consultations
Nuffield Department of Primary Care: Video Consulting in the NHS
Virtual consultations are a powerful tool for clinicians and patients alike, but understanding of best practices, preparation, and constraints are just as important (if not more so) than more traditional forms of care. Telehealth is evolving all the time, but the growing body of evidence shows just how important and valuable a tool it will be in healthcare moving forward. So, if you’re interested in telehealth and virtual consultations — start your research now. I’m only a message away if you need me. In the meantime — go for it. You got this.
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