How to provide a great online consultation!

Things are changing very rapidly with coronavirus and, as health professionals, we need to change rapidly too. This article is to help you make a transition to online consultations and is the first in a series of resources we’ll be sharing to help fellow clinicians in this very challenging time.

I’d like to start this blog with a testimonial I received from an amazing patient I’ve been seeing via online consultations over the last year or so:

“Tom has provided excellent treatment for my knees and ankles to the point where I am free to do what I want and my situation is manageable. The Skype treatment has been extremely effective and I would recommend The Physio Rooms to anyone seeking assistance with physical issues that they are struggling to overcome.” – Erich

I’m sharing this because there’s a perception that online consultation is a poor second best to face to face appointments. It isn’t. There is so much you can do to help and support a patient and it shifts their expectation towards discussion and planning and away from ‘hands-on’ treatments they know we can’t provide online.

With the right approach, an online consultation can be a great opportunity to work collaboratively with the patient, hear their story and plan effective treatment together. So let’s dive into what can help you develop the right approach…

Safety first

An important first step is to ensure you have all the right details for a patient, including their address and an emergency contact number. In the unlikely event, something should happen within the consultation you want to be able to reach out for help.

Legal stuff

Check your liability insurance to make sure it covers online consultations and be aware of any limitations. In particular, if you want to expand your service to include overseas patients there may be restrictions to be aware of. For example, CSP members receive professional liability insurance that covers online consultations but there are terms and conditions, find out more about this here.

What platform?

There are a host of options for online consultations we’ve covered 4 to consider below:

• Skype – many patients will have Skype set up already and it’s free to register. It’s straight forward to use, you just need the patients ‘Skype Name’ and you can find them and connect prior to the appointment. It can be used within an App and you can share images and video. There’s also the option for multiple users and to share your screen if you wanted to show other programmes such as exercise prescription software.
• Zoom – perhaps less well known than Skype but Zoom is also free to register and has an App and many of the same features. You can share images and your computer screen. There’s a nice ‘whiteboard’ feature where you can add text or draw and you can have multiple users. You could run an exercise group or Pilates class through it! Zoom allows you to send an invite to patients which includes a meeting ID and link for people to join the ‘meeting’. You can also add a virtual background but it does look a bit odd!
• Rehab Guru – if you’d like something more extensive then rehabguru.com is a good option to consider. They have around 5,000 exercises with images and video that you can integrate within your online consultation (with a little practice) and send to your patient. They can download an App with these exercises in and record how many they’ve done and what pain they’ve had. There is a cost for this software but they have an offer on at present where you can receive a 50% discount with the code TELEHEALTH. To be clear, we don’t have any financial arrangement with this group, we just wanted to showcase some options for you. Chat to @Rehab_Guru if you have any questions.
• Telephone – yes, that does say telephone! Not everyone will be able to connect via the options above and there’s a lot that can be achieved in a good telephone consultation. Don’t underestimate it!

Below we have a video reviewing some of the features of Zoom and Rehab Guru:

Don’t forget other options like FaceTime and WhatsApp. It’s about finding a solution that works for the patient.

What can you cover?

I had a Skype consultation with a runner yesterday and we got through so much in the appointment! We took a full history of the presenting condition, covered past medical history and medications and explored work and sport including getting a breakdown of her typical week and what it includes. We discussed pain and its behaviour delved into treatment and rehab so far and decided goals for the future. We were able to look at ankle and great toe flexibility as well as calf function and by the end of the appointment, we’d agreed on a plan for return to running and a progressive rehab programme. I’m looking forward to chatting in a week or so to hear how she’s doing!

So much of the important information we gather in a session comes from what patients tell us. The subjective rules! You can add simple movement tests to this, you just need to have enough space and get the patient to move the camera a little. Occasionally you’ll get a lovely view of their carpet but it’s nothing that can’t be overcome with some clear communication.

For more complex tests why not create a video or PDF you can send the patient in advance so they know what to expect in the session? One feature of Rehab Guru that we like is you can upload your own videos and create a template which can be sent to a patient. They can then score symptoms etc during these tests on their App and you receive the data prior to the session.

Don’t just sit there!

I doubt you’d spend an entire face to face appointment just sat down! There’s no reason to do this online either. Be active in demonstrating tests and exercises and get the patient active within the session. Why not do a 1 to 1 rehab session and take the patient through a rehab circuit? Or you can bring a group together for an exercise class or Pilates. Many people are stuck, in-active within their homes at the moment. Be the solution to scratch that itch to exercise!

When is an online consultation not indicated?

The majority of patients will benefit from an online consultation but there are some who may require a face to face appointment. This includes people with serious or high-risk conditions and more complex cases that may benefit from a more detailed physical assessment. The CSP has a great page on some of these considerations and their application here.

In summary, online consultations can be valuable dynamic and empowering for our patients. There are a number of platforms available to us, some with some great features to add to our appointments. Test a few out to familiarise yourself and then start booking some patients in! Best of luck!