What are Virtual Appointments?
‘Virtual’ Clinic Appointments have come to the fore during the Covid-19 pandemic. This is where the Doctor and Patient are remote from each other and are done, either by telephone or by video consultation. In the majority of cases, there is direct interaction between clinician and patient but via a screen or telephone.
Why have these become necessary?
This has, in part, been part of the solution to social distancing required to help reduce spread of the Coronavirus. The pandemic has spurred forward an adoption of technology, which hitherto was considered ‘unsafe’ or not in keeping with traditional clinical models. Whilst the public and many private companies have rapidly accepted Zoom-calls, FaceTime and WhatsApp video-calling, Healthcare in general has been slow to adopt these approaches. There are complex reasons for this. In the USA, there has been complex legislation in different States. There is also significant influence by the software companies that produce patient record software.
How have Virtual Clinics been working?
There are dedicated software packages which vary dramatically in ease of use. On the NHS, I have used Microsoft Teams, Zoom
Naturally, there are both advantages and disadvantages to the new approach. The biggest disadvantage has been for patients – they may need to utilise something they are less familiar with. Some of the software is best run on a home computer or laptop, but in reality, everything must be designed to be Mobile First. Approaches that are designed around mobile platforms will be more readily acceptable to patients and enables them to be more flexible on where they are at the appointment time. Mobile First approaches also tend to be more friendly to use.
What is my experience of running Virtual Appointments?
- Video Consultations vs Telephone Appointments: I feel that video consultations are better in terms of clinical safety and communication. The ability to see the patient directly adds so much to the discussion. There is nuance in communication that is lost in voice-only discussion. I can see the patient’s facial expression when s/he is describing their symptoms. The patient subtlety look away when discussing emotionally painful matters can only be seen and not heard; picking up on these parts of non-verbal communication can be so important in the provision of empathetic care. More obvious things can include cardiac patients instinctively touching the centre of their chest when describing the troublesome central discomfort when they exert themselves. This, so-called, “Levine sign” is so powerful and makes the discomfort much more likely to be true angina rather than another type of chest pain. All of these matters are lost over the phone. More obvious issues, like the patient’s size and weight are also not easily detected over the phone – these issues can be important when considering medication doses or organising certain tests that are body-size dependent.
- Focus: A video consultation requires an additional level of focus from both parties. Both tend to be looking directly at the screen and appear to have less distraction. Telephone conversations can allow the pretence of ‘multi-tasking’ and this certainly isn’t preferable in a clinical setting. Naturally, an excellent Internet connection is required to really achieve this. The counter-point would be a choppy connection leading to a stuttering conversation: this is no good for anyone, especially in healthcare.
- Patients need to have some technological savvy: Whilst the latest Video-consultation platforms have made the process easy, not everyone has coped well in the transition
- Identifying patients best for Telephone Appointments: Telephone Appointments can be helpful when undertaking long-term follow-up with well-known patients. In those patients whom I have got to know really well, a telephone call can be an efficient form of communication
- Timing of Appointments: Virtual Appointments can occur at a time convenient for the patient: I have undertaken consultations in the evening and on weekends. There is total flexibility and it means we can move quickly when providing care.
Are there other types of Virtual Clinics?
Separately, there are ‘Virtual Clinics’ used by some of our NHS services. These are distinct services, separate from ‘virtual appointments’ discussed above and separate from in-person clinics. Essentially, these are appointments but patients do not attend. There are fixed slots to permit the Doctor to review the patient’s latest test results. This can help streamline patient follow-up as there can often be long delays between in-person clinic appointments. In general, these “virtual clinics” can work well when we expect test results to be reassuring, or for those patients have routine chronic monitoring of stable conditions.