We have had to review how we provide our service to patients because of travel and health concerns. It is challenging to continue to operate face to face appointments with the risk to patients coming in, the risk to staff and the additional time it takes to clean down between patients. I have been really impressed with the ability to transfer the consultation skills I have learnt over 30 years to working with video and remote consultations. We have obviously used phone consultations as part of that treatment regime over many years, but it really does add a great deal to be able to see a video picture of the patient as you are talking. Obviously this requires a good internet connection and technology know-how but for the patients consulting with me I think about two thirds have moved away from face to face appointments and about half working with phone and about half working with video consultations.
The purpose of this piece in the newsletter is to try and encourage those of you who currently have phone consultations to if you can get the ability to consult by video. Seeing the picture of the patient as well as the voice really does add to what can be communicated both ways. That means not only do I get more information looking at patients facial expression, mannerisms and eye movement when they are talking but I think they get more from me in terms of empathy and support. Indeed I have said to a few patients who come in and wearing masks that I think I get more ‘engagement’ from seeing patients on video without a mask than sitting in a consulting room opposite each other with masks.
One impact on the change of working in this way has been to really reflect on how many subtle communication and therapeutic clues and offers there are when you work one to one with a person. A lot of those are nuances of body language, expression, challenges and support are communicated at a very subtle level and are part of the experience that a doctor builds up over their career is how to manage these to the best advantage of the patient. Working with video and phone is no different but the information you can base these assumptions on and how you check them out is in its own way different. In many ways with video and audio only calls you have to be much more explicit and direct in your enquiry, open ended questions can fall a little flatter. A large part of how a sensitive practitioner works is picking up on what is transmitted by the patient, often unconsciously about their state. This is sometimes referred to as transference. This transference is like subliminal waves that the experience practitioner picks ups on. We then interpret that information based on past experience and although some times we get it wrong and of course we check it out verbally, quite often it is a strong emotional intelligence and intuitive guide to the direction the consultation needs to take or even a therapeutic treatment pathway that should be trialed. For me the addition of a visual picture along with good sound quality enhance this picking up of the transference. We are ‘tuned into’ those many little cues that we get when we are talking to someone that indicate different things to us. Like the hairs on the back of the neck when you feel you are getting into an unsafe area, the disassociation of fatigue when you are losing the story or going down blind alleys. These are the blunter feelings that go with attending a conversation. In a consultation we fine tune these many perceptions using our body like an instrument to pick up on the most important. Over the years I have known many experienced prescribers rely heavily on these feelings developing a reliable inventory of clues, tales, sensations that will help them navigate through the more challenging, unconscious or hidden parts of the consultation. This is particularly important for complex cases on what we sometimes call one-sided or hidden cases where one overwhelming symptom can make perceiving the whole case more difficult.
It has been a great challenge and if I am honest an enjoyable challenge at this stage of my career to learn a new set of skills around consulting with video. While for many patients it won’t replace the comfort of a face to face appointment the practical reality is that at the moment it is filling a very important gap and I suspect will continue to do so.