Patient-centred online consultation

Bart van Buchem is a NOI instructor, NOI NL Faculty Leader, polyglot and translator, he is also a researcher and clinician. He was wearing all of these hats in writing the following that he has shared with us, along with the video to go with it.

Telehealth is emerging to be the new standard in COVID-19 times to replace face-to-face consultation. For now. Or will there perhaps be a pre- and post COVID-19 era in healthcare? Is it a threat, does it change how we will work or will it cause some interesting changes for the better? Everyone may have their own thoughts.

The learning curve

Since consulting patients online – which I have done for a number of years, although never in this frequency or quantity – it has been tough. It’s a big learning curve.

After a day picking up on verbal cues on a screen in an unfamiliar set up – burning eyes, ‘Help – I can’t use my hands’, engaging patients, writing down notes, helping patients to set up their webcam, sound, wifi… What a day!

Is it effective?

Should you be concerned for your results in therapy? There is, in fact, no difference in goals and objectives. Even the delivery in many cases is very much the same – especially in exercise therapy. When it comes to hands-on therapy, however, things will be more challenging.

Telehealth is potentially as effective as face-to-face – depending on the quality of the online consultation. Of course, more research will provide more insight. What makes quality telehealth as close as possible to face-to-face results? We will go into this in detail.

Some basics – audio, video, and a plan

Quality connection with your patient is critical to best outcomes. A semi-professional set up, at least, is essential. The quality is largely affected by technical specifications. Make sure you have:

    • Stable internet connection (up to 5 mb/ sec)
    • HD camera
    • Microphone (external if possible)
    • Lighting plan.

If you are not fully equipped still try to do the best you can. There are many significant measures you can take to improve the set up. Read on.

Audio

Patients will respond well to hearing your usual crystal clear voice. Consider an external microphone, preferably not headphones because you want to look like a clinician, not an IT consultant. AirPods or similar work well (although sound quality is not great) and allow you to be hands-free, for example when demonstrating exercise. Important: be mindful of your patient’s privacy if you must have your patient’s voice on speaker.

Video

Seeing is believing. This is why creating a comfortable setting is important.  Everything in the environmental context may have an affect on treatment results: what you wear, where you sit or stand, how much space you have to move around. Be aware of yourself before and during a session. Remember, your thumbnail is on the bottom of your screen during the session. From a technical point of view, there are a view things to take into consideration:

    • Experiment with distance to the screen. We seem to sit too close – spatial distance on screen is appropriate.
    • Position the camera correctly. An external cam should be positioned so you are looking straight into the camera while watching the screen. Remember, your facial features can be exaggerated and distorted with incorrect camera angles.
    • Keep your background clean, professional and personable. A bare background may be too clean. Find out what fits in your own setting.
    • Consider your lighting. Watching someone with a light bundle in the background is very uncomfortable. Place your light source in front of you. Daylight is best but if not available utilise artificial light.

A plan

NOI resources will help you to create a framework that will engage your patient to their treatment plan. The Explain Pain Protectometer: Handbook allows you to create a framework (curriculum) for the patients journey to recovery. Completing the Protectometer fold-out in the handbook together and encouraging them to use the Recognise App and/or Protectometer App to set challenges and experiment with context, will provide a set of treatment modalities. Pain education will be exciting and creative as you will be relying on a variety of skillsets. NOI Explain Pain resources are designed to be accessible for a broad audience and have been proven to work for many people. All they need to find is an up-to-date clinician. That might be you.

When does telehealth not work?

Creativity and flexibility will not limit you in treating a person with a certain health issue. Limitations may come into play with screens or devices because of a patient’s physical impairment. If you are feeling uncertain, reflect on your early treatment experience. Did you feel as comfortable as you do now in face-to-face consultations? Probably not – it’s a learning curve. Give it a chance, don’t give up too soon. We are aiming to deliver high value care. If you prefer face-to-face, let’s try to get as close as we can. It’s all about the patient, we need to adapt as much and as fast as we can. It’s only some conceptual and behavioural change right? We are specialists though.

Whatever your preference may be – face-to-face or online – some forms of mobilising and coaching need your physical appearance at some point in time. Today, as here in The Netherlands, all clinicians will be making intelligent choices and considering our patients and our own safety.

We wish you all the best and stay healthy – the world needs you ALL!

-Bart van Buchem

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