Video consultations, challenging our definition of ‘normal’
By Nick Knight – Sports / MSK Podiatrist & Director
Telehealth is a bit of a buzzword at the moment. Firstly I’m not a massive fan of the term telehealth, I prefer video consultation, it sounds more personal.
I believe video consultations were something that was coming in the not-too-distant future and GPs were already being encouraged to look at consultations via this method. However, with the coronavirus pandemic, it has forced us to bring Video consultations forward, as injuries are still going to happen and we need a way to treat people safely. It is going to require a big culture change within healthcare professionals and also patients, as this is a big change to our normal.
We have been doing virtual consultations at NK active for a while now, for our patients that live too far away to travel to the clinic. However, it isn’t something we’ve really spoken about in the past. Naturally, I’m always a glass half full kinda guy, and I think video consultations have a lot of benefits to them. It allows us to have an appointment with anyone, any time across the whole globe. We have many patients who travel a lot for work, so this would enable us to help keep pushing the rehabilitation programme and their treatment plan forward even whilst they are away.
It will allow us to streamline and triage making sure that you can get the most effective treatment when you come into the clinic, for example, if a patient thinks they require a 3D gait analysis or shockwave therapy to help solve their problem, the initial consultation and discussion around this could easily take place over a video consultation when they come to clinic we can get straight into the gait analysis or treatment allowing a more streamlined approach.
The beauty of nice high-definition screens and cameras is the ability to show exercises the patient needs to do, then send the relevant equipment to do it. So far we have shipped many sets of modified off-the-shelf orthoses, stretch boards, tone loops, exercise boxes, wobble cushions, etc. and have been able to monitor people’s progress remotely. This has allowed us to help them push forward, however more importantly help adjust and overcome any setbacks that occur, as anyone who has had an injury will know that the road to recovery is never a smooth one, there are often a few bumps along the way and using video consultation means that we can address those bumps quickly without them coming into the clinic.
With any injury, a good history is absolutely key to getting a correct diagnosis, and working out why a problem has occurred. The art of taking a good history is listening and asking the right questions. I always joke in the clinic when speaking to junior colleagues that we have 2’s ears and 1 mouth, so when in-clinic use them in that ratio. The way I look at my job is a detective really, the patient holds all the answers, I just have to listen and ask the right questions to solve the problem. The beauty of history taking is that it doesn’t have to be done face-to-face, video consultation is a perfect way to do this.
So how does it work at NK active
The only difference between a face-to-face consultation and a video consultation is that we physically do not get to see you in person, the rest of the process is near enough identical.
It is a really slick and simple process and over the past 2 weeks, we have already updated and improved the service twice already.
When someone books an appointment, they are sent the appointment confirmation, within that confirmation is the link for the video consultation, which is a completely individualised link for the patient and is fully encrypted and secure. Also, they get the preassessment questionnaire and registration form, which helps give us as much as history as possible prior to the consultation. During the consultation we delve deeper into the problem asking specific questions to try and work out why the problem has occurred, we ask the patient to do certain exercises and movement, show us their footwear, watch them walk, maybe even ask to record a video of them running. All of this leads to getting that working diagnosis and allows us to discuss a personalised treatment plan by the time we are finished. A full report and letter are then sent out.
Next, we start any treatment plan discussed. Just like a face-to-face appointment, we are with the patient every step of the way so if they have any questions or queries along the way just like normal, just get in contact. During the rehabilitation process exercises are sent out (we use Rehab Guru), with videos and the chance to download the Rehab Guru app, we can track pain and function scores to help keep progressing people forward.
Once the treatment is finished, we still send an email at 6, 12 and 18 months to make sure everyone is still doing all ok, which all goes into our audit data to show how effective we are and help us to make changes to offer a better service.
What can you do over a video consultation
Just because we don’t physically meet, there is still plenty we can do to help you:
- Diagnosis and bespoke treatment programme
- Bespoke Rehabilitation programmes
- Insoles (orthoses) provisions
- Exercise advice
- Taping advice
- Footwear advice
- Referral for X-ray, Ultrasound and MRI scans
- Referral to other health care professionals
- A full report of your problem and treatment programme
- Provide rehabilitation equipment
- Remote management, helping to you on track whilst on the go and save time on travel
What are people saying about video consultations
We already have a number of reviews from patients who have used the video consultation service.
“ I had heard good things about this clinic, but as we live a long way from it, I made use of the virtual appointment facility after my teenage son injured his foot and it wasn’t resolving. The service was easy to use, and Nick was soon able to reach a diagnosis after some in-depth questioning and remote assessments. His knowledge was extensive and full use of the available technology used by Nick ensured that my son and I understood the problem and the specific exercise programme required to resolve it. Highly recommend this great virtual service wherever you are in the UK or even the World. Thank you Nick “
Dianne Small – From NK Active Facebook Page
“I would not hesitate to recommend the video consultation from NK active. The process is easy to arrange and understand. Nick is very friendly and knows his stuff!
The rehab programme was quickly delivered to my email and the equipment I needed for this was delivered speedily too.
Looking forward to our follow up consultation to assess my progress.
Thank you NK Active for helping me out!”
Rachael Cummings – From NK Active Facebook Page
What can’t we do? Will everything become video consultation eventually?
Obviously, there are certain things that are difficult to do a video consultation, for example, we are not able to do our 3D gate analysis or shockwave therapy over video consultation, currently, as it stands we are unable to take impressions for the bespoke orthoses, however, I am working with a couple of laboratories so we can try and offer this service remotely as well. Also, there are some complex cases where you just need to assess the lower limb to check for a range of motion, strength, etc that require a face-to-face consultation. So I do not see video consultation taking over, I just see them as another string to healthcare clinician’s bow and another way to help people get active and stay active. I really do think in the future the treatment and rehabilitation for patients will be mixed with face-to-face and video consultations. It is certainly leading to an exciting future.
Hopefully, this gives you a flavour around video consultations, answers some of your questions and starts to breakdown the barrier around them. If you have any questions or queries, please do comment or just drop me an email email@example.com
If you want to learn more you can just head to our website.
And we will see you soon,