Telehealth – a few tips for consulting during the coronavirus pandemic, April 2020

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This is week 3 for me consulting largely online, during this necessary and mandated time of physical distancing requirements. It is challenging and essential that we all do the best we can to help in continuing to ‘flatten the curve’.

Whilst an experienced clinician, and ‘ok’ with technology, I am no expert at online consulting. However, I have discovered a number of factors which help to make things work, and share these for whatever assistance may be able to be gained by colleagues, in a similar position.

Hardware: a laptop, and internet connection – I have raised the specific laptop to align the in-built camera with my face.

Platform: there are many. I am using Zoom, which is free and has markedly increased its security with better encryption, passwords, secure ‘waiting room’ etc. Check the security of your own system to ensure adequate virus protection and firewalls. Others I know (including corporate executives and schools) are using MS Teams, CoViu (fee), Skype.

Ensure that you shutdown daily, to get the latest updates and any bug fixes.

 

Lights, camera, action!

Setting: it needs to be quiet and professional, just as you would present physically. I am on-site in clinical rooms (dressed accordingly), with an anatomical foot model at hand.

Lighting: As every photographer knows, you need light on the subject’s face. I am in a room with floor-ceiling glass windows, and so draw a blind on one side and use a lamp above and in front of my head (out of sight).

Audio: I have not needed to use earphones of any description, but many prefer, including some patients.

Privacy: telehealth is a private and confidential consultation, so ensure you are alone in the room, and close the door as you normally would. I do not record any sessions, and would never do so without agreement and consent from my patients.

Consent: Existing patients have already signed a consent and privacy agreement. Any new patients have to have signed and returned these same forms before the telehealth consultation can proceed. As always, double-check that the provided information is complete.

 

History, history, history!

Thorough history taking is always the primary information source of every consultation, and telehealth does not change this fact; perhaps enhances it even further.

Notes: To keep my eyes on the screen and focus all attention on the child/parent, I jot notes using a basic SOAP format. [In fact, given the coronavirus, it is very much the time for ‘AMPLE SOAP’].

It is crucial to write up fully (we use FrontDesk software) asap. I generally summarise the consult verbally with patients, and ensure that my SOA-Plan is complete.

Time: All of my telehealth consults are 30 minutes, or longer as required. Generally, I find I need this time, and it allows time to double-check any coached examining and testing.

Patients: clearly telehealth will not enable you to treat with instruments. I have though, shown a patient how to apply a basic taping for heel pain (3 long/3 short strips; which thankfully provided immediate relief for him). I coach patients through self-examining and provocation tests; often demonstrating myself. Feet, footwear, and gait are all easily visible; range of motion, palpation by proxy, strength and balance are all possible to assess; I can demonstrate exercises, and then watch/improve the imitation.

I see mainly paediatric patients, who attend (in whatever medium) with a parent or carer. I have had terrific cooperation from parents, and they are really appreciative of being able to get help or follow up, without the concern accompanying a physical clinic visit.

In essence, I have tried to maximise my patient list using telehealth. We have also encouraged non-essential visits to be deferred, and basically only physically see patients who will be worse off if they are not seen, eg an infection.

The children think it’s fun, and there have been some great laughs! I have been ‘bombed’ and barked at by the family dog, shown goldfish, cats, budgies, lizards and hundreds of Easter eggs. I have automatically washed my hands between telehealth consults a couple of times, and even worn a mask (causing great amusement!).

Follow up: I try to provide really clear guidelines around what is expected, what is ok, and what is not. I do think it’s important to offer easy communication access (email, phone, follow up telehealth appointments) should there be any concerns. Some are a bit anxious just now, and it’s good to provide easy connection options, if needed. If I have any doubts or suspicions, I am calling (as agreed) to check-in after a few days.

Postage: We are posting items to patients wherever possible to reduce physical contact. If sending any form of insole or foot orthoses, it helps if people send a photo/tracing of their sock-liner (and shoe size) to enable trim-to-fit, prior to post/delivery. I have known some of my patient families for many years, and so offer to drop-off items on my way home for them, and they are very appreciative.

 

Be aware for – Covid-19 foot signs; it may not be a chilblain.

https://metro.co.uk/2020/04/15/bruises-feet-sign-coronavirus-12557291/

Resources: The APodA have done a great job of keeping members (and non-members) abreast of the many changes, requirements, supports and resources as these have become available. For telehealth-podiatry specifics, please check:

https://www.podiatry.org.au/about/news/telehealth-for-podiatrists

I have also picked up a few tips from the RACGP guidelines:

https://www1.racgp.org.au/newsgp/professional/new-guidelines-for-telehealth-consultations

 

Thank you for viewing this 2020 Evidence Essentials blog. Stay well, stay at home please!

Kind regards,

Angela Evans

Dr Angela Evans AM       

PhD, FFPM RCPS(Glasg)

www.evidenceessentials.com