Telehealth has come a long way since March when the MBS introduced new item numbers for GP consultations in a funding program worth more than $650 million.
Over the months, doctors have participated in millions of telehealth consultations and Ausdoc.JOBS has experienced a surge in interest in telehealth positions, both from advertisers and applicants.
We asked practising Queensland GP and telehealth entrepreneur Dr Jared Dart to share his thoughts on what makes a good telehealth consult.
It's a learning curve, he says. The first priority is to ensure you have the right technology. Not only the correct computers, webcams, speakers and apps. It could also be as simple as having enough telephone lines and internet bandwidth.
"When you set up a practice, you don't expect every practitioner to be on the phone at once," says Dr Dart, who completed a PhD in eHealth 15 years ago.
Dr Dart is the founder and Chief Medical Officer of Welio, a cloud-based telehealth platform provider that enables effective patient engagement and seamless billing. Here are his insights for a good consult:
Let the patient choose their medium:
Younger people are comfortable with video. It's their default. They do things like walk around with their laptop and take you out onto the balcony and the kitchen. They have an authentic mobile video experience while they're talking about their condition. Older people may be happier at a desk and sitting down and looking presentable. Some people may be camera shy or unfamiliar with the technology, which might make a telephone consult preferable. Dr Dart's practice always emails patients instructions, which include notes on disabling the camera if patients prefer.
Children should be seen and heard:
Video is preferable for child consultations. If you can see a child, you can be much more comfortable that they are not seriously unwell versus what their parent reports. Children under two can be very difficult to assess remotely if there's a concern that they are unwell. In our practice during the lockdown we pretty much did a teletriage, and we would examine kids under two in person.
Speak to the camera:
The interesting thing about video consults is that it is natural to look at your patient on the screen. But the camera is typically above your monitor, so your patient will not be getting eye contact from you. From your side, it's useful to watch their micro-expressions to see how they're responding, which may help indicate if they're unwell or mildly unwell and assess things like their affect and mental health. There's less imagination required with video than there is with the telephone.
Get the balance right:
Physically unwell patients need a higher proportion of face-to-face appointments. For my relatively well patients, I would like at least one face-to-face consultation out of their two to three visits a year. That gives an opportunity for a skin check, to listen to the heart, check blood pressure etc and to build rapport.
Dr Dart gives the example of a geriatric patient who put on several kilograms of fluid during the COVID-19 lockdown. “I would have picked that up in our monthly visits. She didn’t notice it and I couldn’t see it over the phone! That's a downside of telehealth with no face to face.
Ask patients to do some homework:
For my heart failure patients, for example, I ask them to have their blood pressure, weight and heart rate data ready for the consultation. I have asked some of them to buy pulse oximeters. I ask my asthma patients to do their peak flows before we consult. But access to biometric data – blood pressure, weight, heart rate, heart rhythm etc – can be a challenge. Going forward, using COVID as a catalyst, we need to build out those capabilities and find ways to fund them for people who can't afford them.
Don't do rashes:
Rashes are something to avoid because you need to have a better view than what a video or photo can offer. I don’t like photos unless there is no alternative because for me a rash is contextual. Sometimes you want to know how rough it is, if it is flaky, where it is and isn’t and if it is blanches or not, for example.