Top tips for remote MSK consultations

Diarmaid writes:

The use of video technology involves a reframing of the clinical consultation. See it as a virtual home visit, improving the accessibility of your service, not just implementing new technology. It isn’t a replacement for usual face-to-face consultations, but it does offer a unique window into a person’s home and allows a more relaxed clinical encounter.

Three things to do before commencing video consultations

• Watch Trish Greenhalgh’s excellent webinar and guide, Video consultations: how to set them up well, fast? Trish is a GP and Professor of Primary Care Health Sciences at Oxford University.
  All help guides are based on her work including NHSE - Using online consultation in primary care- implementation toolkit.
• Check your local Digital exclusion heat map. Find out if there’s support available in your organisation, useful documents, operating procedures etc. Any issues have most likely been experienced by others and addressed.
• Use Fraser Ferguson’s AHP Scotland infographic as a template of what to do in a consultation during COVID-19.

Then ‘plug in and play’, practising set up and skills with your colleagues. Common platforms Attend Anywhere and ACCURX are very intuitive and user friendly.

What I have learned

• Prepare yourself – check software and hardware before each session, check lighting and no striped shirts! Have a back-up telephone available in case of connection problems.
• Prepare the patient – send out pre-appointment information, check hardware and internet access, have a quiet room with no distractions, remind to dress appropriately, remind to think of ICE (issues, concerns and expectations) and ‘Ask 4 questions’ prior to any consultation.
• Use a structured and scripted introduction – this allows any tech issues to be ironed out, makes the patient more comfortable and frames this as a medical consultation not a zoom chat.
• Consultation – subjective consultation feels more relaxed as the patient is more comfortable. Salient objective tests may be delegated to the patient. They can perform range of movement exercises, dermatomal tests, resisted muscle tests and functional tests guided by the clinician.

We have recently managed patients with a variety of conditions: knee OA − self-care with online ESCAPE-pain programme; Achilles rupture − referred to trauma team; mobility problems − referral to Community Hospital admission avoidance team; suspected CES − referred for urgent MRI and referral for possible metastatic lung cancer.

Virtual consultations can have added benefits for those with long-term conditions such as persistent pain, as they remove the burden of commuting, which can be exhausting. They allow this energy to be focused on what matters to the patient in a more comfortable environment, helping them manage their long-term condition more effectively.

Always remember the patient is inviting you into their home and we as clinicians should be mindful of this, as this platform is here to stay.