Face to face or Video Consultation?

Choosing whether to have a video consultation or a face to face consultation.

There have been some significant changes to the way that we work during this Corona virus pandemic. This is affected the whole of humanity in a way that we couldn't have anticipated and none of us have experienced anything quite like it before. At the beginning of March this year, I really felt that video consultations were not something I'd want to consider. I have, on the contrary, found them to be very helpful. In fact, so much so that I'd like to continue to offer them after the restrictions are removed.

At this point I believe they will still be funded either through private medical insurance and possibly through the NHS ‘choose and book’ scheme. Self pay patients can also choose a video consultation if it seems convenient. In fact, a self pay consultation may cost less than the travel costs to my clinic. Some of my patients travel a long way and sometimes need to stay overnight in London. The amount of money and time saved is invaluable and relieves my guilt!

I think it is quite difficult to know whether a video consultation will suffice. This blog is about helping patients choose whether to come to see me for a consultation whether to choose a video consultation instead.

Good examples of when a video consultation might be appropriate are listed below.

A patient who wants to see me for the first time, who may already have had some investigations done, may wish to consult me for some guidelines as to what to do next. If there are any previous investigations, I'd like to have these beforehand and these can be sent to my secretary. We could then come up with a plan for any further investigations that may be required.

There are some conditions that I would be happy to make a decision about surgery without physically meeting the patient for example contractors in the finger or trigger finger or ganglion surgery. These diagnoses are obvious. With careful history taking we could minimise the chance of any contraindication to surgery occurring when we meet on the day of the operation. Indeed, I would like to have a much higher incidence of ‘active’ consultations when these restrictions are removed. That is to say that steroid injections, or removal of sutures, or change of dressing, or a removal of a cast would be appropriate for a face to face consultation obviously. Some of these can be done by district nurses and during the time of these restrictions  I have even helped patients through the removal of their own dressings and stitches in the video consultation. We've achieved things that I could not have thought possible prior to the lockdown.

Another nice example would be a patient who has had a good result from an intervention and simply wanted to check with me whether there was anything else they should do. It is often nice for me to see the end result. I often tell patients not to keep their appointment if all is well, but it is nice for me to see the patients that have done well, so a video consultation is ideal for this.

Another example would be a patient who had had conservative treatment for a condition that was steadily worsening. As the condition progresses there often comes a time when surgery becomes necessary and we could often make that decision in a video consultation having previously met in person.

If the clinical problem clearly requires me to feel the wrist or hand for tenderness, or for clicking or small lesions which can't be seen easily, then a face to face consultation would be more appropriate.

I hope that using these guidelines patients can help to save unnecessary journeys and it may well be that most of the patients ‘pathway’ can be managed with remote consultations instead, with attendance at clinic happening only when absolutely necessary.