Remote consultations have now become embedded into the healthcare system, as a way of keeping in contact with patients and ensuring their continuiong care during this pandemic. NHD columnist, Louise Robertson, Specialist Dietitian in IMD, becomes our guest blogger to discuss the pros and cons of the digital consultation.

In the NHS, remote consultations were virtually unheard of before COVID-19. Our hospital was in the process of trailing some video conference technology, but only with a few teams.

Then lockdown hit us and all physical outpatient appointments were cancelled. Some consultations could be put on hold, but others needed to continue for the safety of the patients.

I work with patients with Inherited Metabolic Disorders (IMD) and our aim is to keep our patients safe at home, managing their medication and dietary treatment well, so they don’t end up having to come to hospital. So, we needed to continue with their appointments for their safety.

We were one of the first teams to start using the newly bought-in video conference system. We had to iron out a few problems. At first the video portal would only let the patient and the consultant join the video consultation room, the rest of the MDT team (nurse, pharmacist, dietitian and physiotherapist) were left waiting to be let in! Luckily, after a few emails and phone calls, IT opened multiple links to let us all on!

THE ADVANTAGES

There are lots of advantages of using remote consultations. Here are three important ones:

• Patients are more comfortable in their home environment.
• They save money and time not having to travel (often long distances) to the hospital.
• They are not going to be a risk of being exposed to the virus.

As healthcare professionals we can peek into a patient’s home to get a feel about the person. This can help form our assessment. The patient can show us what food they have in their cupboards so we can help and support them with their nutrition choices or give advice on reading labels.

We have managed to connect with some patients who often don’t want to come to the hospital. This might be due to anxiety or long, costly travelling times. So, for some people, remote consultations suite them better.

THE DISADVANTAGES

There are also downsides to remote consultations:

It is hard to get accurate anthropometric measurements

Asking patients to go and stand on their bathroom scales to find out their weight does not always give accurate results, or they may not even own any scales. This will be harder in Paediatrics, especially if weight is a very important factor to monitor if an infant is failing to thrive. I have heard of clinics loaning scales or setting up drive-through weighing stations!

Blood test are hard to organise

A patient might have to go to a special blood sampling hub or to their local GP. Some of our IMD patients will have access to home monitoring systems, such as blood glucose meters, blood pressure monitors or dried blood spot sampling. Wouldn’t it be great if each patient had a wearable device that sent back information to their clinic to monitor!

Some patients may have digital reluctance

There are patients who prefer to use the telephone and others may have ‘digital poverty’. They may not have access to Wi-Fi and don’t want to use all their data up on a consultation.

One of the things we may miss with patients is the subtle clues that we may pick up with a face-to-face consultation. Are they really struggling, but too worried to tell us? We miss the general chit-chat that we may have with a patient while they are in the clinic or waiting room. Sometimes we gain valuable information this way.

In a recent metabolic dietitian meeting, we were all asked if we should continue with remote consultations post COVID-19. 100% of us said that we would like to use them in conjunction with face-to-face appointments. That way the patient and the consultants get the best of both worlds.

There are pros and cons to face-to-face as well as remote consultations. What suits one patient may not suit another. However, from the dietitian’s point of view, it will be beneficial to have the option of both in order to fully support our patients.

Louise Robertson RD
Specialist Dietitian: IMD

Louise has been a specialist in IMD for 12 years,
at University Hospitals Birmingham NHS Foundation Trust.
She is also the dietitian for the Galactosaemia Support Group
and runs her own blog Dietitians Life (www.dietitianslife.com).
She, along with her colleague Sarah Howe, also writes
NHD’s Dietitian’s Life column in each issue.