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COVID and telemedicine: video consults are the future

Video consults just as effective as in person appo
Photo: COVID and telemedicine: video consults are the future
A GP has described practicing during the COVID-19 pandemic as “challenging, exciting, interesting, depressing, upsetting and fraught – all of those things together”. But his experience in shifting towards telehealth practice has highlighted how video consultations can often be just as effective as in-person consults – if not more.

“I haven't had much direct involvement with patients who have had COVID-19, but I certainly have had plenty of patients who are anxious and worried about COVID, and have been impacted by the effects of pandemic”, said Dr Andrew Baird, a GP based in Melbourne.

“In regard to lockdown and restrictions on activities, this has had a huge impact on people’s personal lives, their relationships and their work – and their social and mental wellbeing”, he told HealthTimes.
Dr Baird said that his clinic’s switch to using telehealth technology – where he has focused on utilizing video over than phone consultations – has highlighted how beneficial this option is for patients during this challenging time.

“From the medical side of things, they don't have to attend a medical practice in person so they're minimizing their risk of exposure to transmission of infection, and their risk of transmission to others as well.”

“There's also the benefits of convenience - not having to travel to and from a clinic can save on the costs of parking and childcare if you need to get someone to look after your kids while you're visiting the doctor.”

“The downside of that is that not everyone has a private space at home. And if we have family concerns, like when there is dysfunction at home, if there are problems in the relationship or there's violence, then that can make it very difficult to access help.”

“I mean, I've had consultations with people who've been in the bathroom, in their laundry, or they're sitting in their car in the driveway. But still - it's been safe, convenient and private for them.”

Dr Baird said that telemedicine should be a long term priority and not limited to the confines of COVID-19. 

“What happens when the next pandemic comes along?”, he said.

“We're learning that there are many situations where video consultation is as good as, or if not better, than in-person consultations.”

“You don't always need to be sitting in a room in person with a medical practitioner. In many situations you're able to do a perfectly good assessment without physically being in the room, unless you do need a direct examination where physical contact is necessary - and that's not actually all that often.”

“The studies haven't yet been done, but I have a rough estimate that probably 50% of general practice consultations could be done successfully, effectively, appropriately and safely by video consultation.”

Dr Baird there are some practical adjustments that health professionals need to employ to get the most out of telemedicine.

“There’s certainly a structure or format of the consultation when you first see the patient - you do have to do an effective identity check. You need to make sure that you're speaking to the real person. And you need to know where they are in the unlikely event that you would need emergency services.”

“There are some techniques which are helpful in a telehealth consult, like talking more slowly and allowing pauses so that you're not talking on top of one another. You need to be able to do a lot of summarizing, a lot of active listening, being able to ensure there is an agreed upon plan which the patient has understood.”

Dr Baird said that doctors can utilize a number of features in video technology to get the most out of a consultation.

“There's a lot of the workflow that happens in a GP consultation, which can be done remotely. You can send referrals and investigational requests that can be done securely through call.”

“With the video call, you can share images, and you've got the option to use a whiteboard for sketches, which I've found quite useful in discussions around vaccination – and you can't really do that with the telephone consultation.”

“If a patient has a spot or a rash, which you can't see very clearly on the webcam, they can actually take a photo of that and send that directly to you.”

While the benefits of video telehealth have been clear for Dr Baird’s practice, there are several obstacles to the increased uptake of this platform.

One being the need for ongoing funding through Medicare.

“The Department of Health has committed to funding telehealth but the model is going to change and we don't know how the model is going to change.”

“We've seen changes recently since 1st of July with the cutback on the telehealth Medicare item numbers, which have been culled back to about eight item numbers.

The second factor is the willingness of GPs to use video technology, given that research has shown that GPs prefer to use the telephone for remote consultations.

“About 98.5% of telehealth consultations are by telephone and 1% or less are by video”, Dr Baird explained.

“There is a perception that video is too difficult to do and is of limited value, so there needs to be education and up-skilling and training for GPs to appreciate the value of video consultations, but to learn how to use it."

He said there was also a common belief that sophisticated technology is required.
“But the platforms we use are not bandwidth hungry. You can get 300 kilobytes per second and do very well in a video consultation.”

“I mean, it would be great if everyone had top-notch broadband, but what we have is good enough.”

He said that for patients and doctors alike to get the most out of the technology, it’s important to use a platform that’s especially designed for medical practice.

“I use HealthDirect video call, which is the government's funded version of the technology platform COVIU, and it's been purpose built for medical practice. It fits in with the workflows, and it's incredibly easy to use for both patients and for GPs.”
COVIU has now delivered over 4.5m video consultations - currently, around 20,000 consults are conducted per day using the service.

“As I tell patients, there's fewer clicks to do a video call than to make a phone call. We've got to move away from the perception that you're going to be plugging in webcams and plugging in microphones just to have consult”, Dr Baird said.

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Charlotte Mitchell

Charlotte is a published journalist and editor, with 10 years of experience in developing high-quality content for national and international publications.

With an academic background in both science and communications, she specialises in medical and science writing. Charlotte is passionate about creating engaging, evidence-based content that equips the community with important information on issues around healthcare, medicine and research.

Over the years, she has partnered with organisations including the Medical Journal of Australia, Cancer Council NSW, Bupa, the Australasian Medical Publishing Company, Dementia Australia, MDA National, pharmaceutical companies, and state and federal government agencies, to produce high-impact news and clinical content  for different audiences.