10 practical tips to make your online consults BETTER

Online consults have become a big talking point amongst healthcare professionals and many have had to take their trade online with the current Covid-19 pandemic. It can be challenging and a little discombobulating at first but here are 10 things that you might want to bear in mind when you come to do It and could even improve them : )

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See it as an opportunity

We should not view this move into the online world as inferior or sub optimal, just different! In some ways it might actually be superior with people feeling comfortable in their own environments and not having the stress of travelling to us.

It also provides opportunities to focus on areas us HCPs have been discussing upskilling in for years! Building better relationships, communication, advice, coaching & promoting self management are all things I hear regularly discussed as being under emphasised. Well now is time to put away the ideology as these are the tools at your disposal, like it or not. See this as an opportunity to practice, make mistakes but ultimately improve in these areas. Healthcare might not look the same anyway after all this.

Remember interaction IS intervention!

Don’t turn it into a call centre experience

The biggest mistake I have personally made and also hear about from patients is that it seemed like people were following some kind of script. In this format we have to really rely and even cultivate relationship and rapport. Without this you are simply not going to get the information you need later on in the consult.

 The term tele health is horrible, it conjures images of huge room of people wearing headsets going down a list of questions. I guarantee this is not going to be great for building rapport. Make some small talk, check in to see they are doing OK at the moment, hell even crack a joke or a smile. We are all humans after all.  Your personality is your biggest asset to make people feel at ease, cared for and confident in your abilities.

Don’t worry so much about the things you can’t do

The biggest worry I see at the moment from HCPS is about all the things they CAN’T do.

Neuro screens, special tests etc, yes these are all going to be tricky but also inconsistent and unclear at the best of times. Make sure you have your red flag questions (yes we know they are not perfect) and index of suspicion firing on all cylinders as well as a potential pathway to send people down if something does crop up.

But essentially focus on the things you can do really well such as listening, communication, education, advice and coaching skills.

 Set expectations

 Things are going to have to happen a bit differently, there is no way around this. Firstly we need to address and validate this, some of the things we are used to doing and people expect are going to be off the table.

Helping people to understand what to expect and what both you and they will have to do in this new format is really important. It’s a collaboration with responsibilities on each side.

 Subjective assessment

 The majority of diagnosis is symptom related rather than coming from objective testing. Lots of our tests simply tell us there is pain in a specific area, people can tell us that too!

Key aspects are going to be specific activities that cause pain, aggravating and easing factors and also how the pain behaves.

 What’s the severity of the pain and also the irritability? The irritability often gives us more information than severity IMO and is under discussed in comparison to the ‘pain score’. But find out more about the problem rather than just trying to find the tissue. Its also a good opportunity to practice your BPS skills and help people to think about some other contributors to their pain.

 Objective assessment

 Although clinician driven special tests, palpation and muscle testing are pretty much off the table these things can often be limited in utility anyway. We can still look at an area for signs of swelling, inflammation deformity (make sure light is good), we can still do pain provocation tests by getting people to load the area via movement, think a hop for Achilles tendinopathy.

Range of movement is still pretty easy via a laptop webcam or phone camera you just have to make sure your positioning is good. The more you practice these things the easier they will become.

 Don’t forget the best special test is always what the patient CAN’T do or wants to be able to do. These are often task driven rather than tissue driven and give us a lot of stuff to work with.

 Treatment

This is probably the biggest challenge for some who are used to using massage, mobs and manips, needles and electrotherapy etc. We may have to redefine what we see as treatment as the traditional routes that therapists and patients alike expect are just not open to us. Get over it and move on. Treatment will have to be driven by the person not by you. Make sure you have the skills and mindset to do this.

Home exercise and coaching

This will be your bread and butter.

Its ok to take some time to coach some movements and exercises online, in fact this is where you might spend a lot of time. This is not as hard as it sounds with the quality of modern technology. Make sure your cuing and instructions are clear, concise and above all simple. No fancy muscle contraction cues as you cannot poke and prod to get people to ‘activate’.

Use objects in the house such as chairs to limit or increase ROM and use external cues to help people move in some different ways. Its challenging but pretty rewarding when it all works!

 Equipment

 Make sure that exercises that you suggest are able to be done by the person with the current equipment they have available or can be obtained easily. That heavy slow resistance with a barbell or leg press might not be on the cards at the moment so think about some alternatives for resistance such as bags of sand or books in a rucksack or sports bag. Resistance bands give a lot of bang for the buck and are exceptionally versatile too.

 Planning 

So bearing in mind treatment might now look a bit different for some the plan they get is probably the most important thing that you can do for people.  Make sure people know exactly what to do, when to do it, how much and how intense. I often give people a weekly plan with different things to do from little bits of movement right up to more intense workouts.

But without the plan and good instructions many rehab programs fall flat. Don’t just worry about the stuff at the beginning, make sure you spend enough time at the end on the thing that will really make a difference.

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