How-to guide to remote consultations for practitioners

This section includes downloadable checklists of the technology and resources you will need to carry out a video or telephone consultation, and how-to guides on what to do before, during and after a remote consultation. There are also tips for communicating well and maintaining rapport, practical tips to ensure the consultation runs smoothly, and tips for involving family members or carers.

A quick how-to guide

Before the consultation

  • Ensure the patient has been sent details of the appointment including clear written instructions on using the technology and the resources they will need (see our patients’ checklist). Consider sending information such as advice leaflets or exercise sheets in advance. If possible, speak to the patient about this before the consultation as well.
  • Check that you have the necessary technology and resources (see our practitioners’ checklist)
  • Log in to the platform you will be using (e.g. Attend Anywhere) and check the settings
  • Have a practice call if possible (ideally using the same device you will be using with the patient)

During the consultation

  • Accept the call from the patient and check their identity. Introduce yourself and any other practitioners including their name and discipline.
  • Check that the technology is working as expected and that the patient is comfortable using it – if not, you may need to telephone instead
  • Record consent for the virtual consultation in the patient record (electronic or paper-based) – your organisation may have a consent form that needs to be completed
  • Ask the patient if they have anyone present to support them (and that they are happy for them to be involved) and check the safety of the surroundings visually and verbally
  • Explain the purpose, structure and expected length of the consultation. Establish the patient’s expectations and what they hope to achieve
  • Make use of screen sharing and chat/message boxes to share information and resources (such as links to exercises). If you plan to send any follow-up information by e-mail or post, take care and confirm the contact details for confidentiality purposes.

At the end of the consultation

  • Verbally summarise the consultation and next steps.
  • Don’t simply say, “Come back if things are worse” – instead clarify what worse looks like and be specific and time-framed (e.g. “I would be concerned if in two weeks’ time X symptom is happening more than once a day).
  • Offer the patient the opportunity to clarify anything and ask questions.
  • Tell the patient what to do / who to contact if they need help.
  • Inform them you are going to end the consultation before signing out.

After the consultation

  • Record the appointment outcome as ‘Video consultation’ (e.g. in Attend Anywhere).
  • Record the consultation in the patient’s record, adhering to your organisational guidelines.
  • Send any follow-up resources to the patient – this could include an e-mail summary of what was discussed, but take care to maintain confidentiality (check your local information governance policy).
  • Book a follow-up consultation (video or alternative format) and record this in the patient record.
  • Consider capturing patient feedback on the video consultation to improve your service.

Downloadable checklist and how-to guide

Communication tips

Be even more aware of your communication clarity –  mumbling may not carry so well over the net!

Physiotherapist, Musculoskeletal

  • Speak slowly, clearly and confidently.
  • Patience and a sense of humour are important.
  • Give clear and simple instructions and don’t be afraid to repeat yourself to make sure the patient has understood (or to ask them to repeat anything).
  • Use summaries and repeating back to make sure you and the patient have a mutual understanding of what has been discussed. Reflect back specific observations to see if the patient agrees.
  • In video consultations, use non-verbal language such as gestures to keep the patient engaged, but remember that too many rapid movements can be distracting!

You almost need to have a bigger personality to help keep interest.

Physiotherapist, Neurology


  • Try to keep vocal cues such as ‘mm’ and ‘uh-huh’ to a minimum – instead show that you are listening through eye contact, nodding and facial expressions.
  • Aim to make sure only one person is talking at a time. Recognise that silences are okay, particularly where there are lags in video consultations due to poor internet connections. Allow time for pausing and thinking.
  • Reassure the patient that you are focusing on them. Let them know if you will be looking away from the screen (e.g. when typing up notes).
  • Remember that you are not trying to replicate the face-to-face consultation – some things will be different over the telephone or via video.

Further reading: This article by Roberts & Osborn-Jenkins (2020) includes detailed guidance for practitioners on effective communication in remote consultations

Practical tips

Before the consultation

If you are planning a remote consultation, explain to the patient what will be required. You may want to take a look at our patients’ guide.
  • Telephone triage has been used successfully by many practitioners. This will enable you to explore the need for, and feasibility of, a video consultation with the patient. You can establish a clear view of the patient’s ability to use technology and what support they have from family members or carers.
  • When arranging a telephone consultation with a patient, be aware that many people have call blockers or guardians on their phone, or might not answer unknown numbers. If you are calling from your workplace the number may be unknown or unrecognised. Talk to the patient about this, pre-arrange an appointment time and text just before the consultation if necessary.
  • Consider e-mailing (or posting) information and resources such as advice leaflets, exercise sheets, exercise DVDs and website links before the consultation so that you can refer to them during the consultation.
  • Check that the patient is agreeable with the technology at the beginning of a video consultation – if not, telephone or face-to-face may be more suitable.

A suitable space

Try to pre-arrange a suitable room for the consultation to ensure a good physical assessment. Consider the following:

  • Make sure you have a private room where you will not be interrupted - the patient should feel like the time is dedicated to them, as you would in a face-to-face consultation. Ensure that no confidential information (e.g. case notes for other patients) is in sight. If you are planning to demonstrate movement, ensure you have sufficient space for this.
  • Make sure your room is well-lit but avoid glare – don’t have your back to a window! Ask the patient to do the same.

 

Camera and device positioning

Top three tips? Position of camera, position of camera, position of camera!

Consultant in Rehabilitation Medicine

For you:

  • Place your device/camera at eye height if possible.
  • Don’t sit too close to or too far away from the camera – the patient should see your head and shoulders when you are talking, but go further back if you are demonstrating movement or exercises.

For your patient:

  • Ask the patient to set their device down somewhere stable. If possible, encourage them to move towards/away from it rather than move the device:

Have somewhere to place the camera close up and at a distance to enable toggling for full body and close up views.

Podiatrist

  • If you will be assessing several different tasks or activities, it will likely be necessary to ask the patient (or their family member or carer) to move the camera around. For example, when changing between walking, sit-to-stand and upper limb assessments.
  • Try to get a view of the patient from different angles – this will help to make up for the lack of a 3D image.

"There is a wealth of information/exercise videos/teaching videos – make the most of these so the patient can access further support and guidance digitally. This may improve digital buy-in. Take the time to organise, collate and even create these resources for patients so they can be quickly and easily accessed."

Physiotherapist, Musculoskeletal

Timings and planning

Allow at least the same amount of time for a virtual consultation as you would for a face-to-face appointment. You should allow more time for possible technical difficulties, particularly if the patient is new or unfamiliar with technology. 

For patients you may have to consider a paying-forward approach by having a session focused on setting up a video consultation, maybe alongside a family member to help.

Physiotherapist, Musculoskeletal

Plan assessments carefully – ensure there is a logical order to reduce fatigue and make it easier for the patient. Try to minimise the number of times you are asking them to change position.


Give the patient plenty of time. I have found people rush during video consultations - they need reminders to slow down.

Speech & Language Therapist


  • For video consultations in particular, allow sufficient time between appointments in case there are delays (e.g. due to technical issues), and for pre- and post-consultation actions (see our how-to guide). If your clinic is over-running, make sure subsequent patients are aware of this.
  • Allow time for reflection on individual cases and next steps regarding management – you might normally do this when you drive between appointments or chat with colleagues in the office, but it is easy to forget when you are working remotely.
  • Allow time for breaks – you may experience screen fatigue, so don’t try to do too many consultations in an hour or day. Get up and move between appointments. Try to stick to your contracted work hours.
  • Maintain a professional appearance - look smart and tidy and dress as you would in a face-to-face clinic.

 

Involving family members or carers

Ask for a second person to act as a supporter for remote consultations where possible – but make sure the patient is happy for them to be involved. The supporter may be a formal carer, family member, friend or neighbour. 

Patients with severe physical, cognitive or communication impairments, who are anxious or lacking in confidence with technology are more likely to require support from a carer or family member.

Discuss with the supporter how much they will be involved during the consultation / what their role will be. They may play an active role in assessments:
  • Feeling and describing joint movement; 
  • Assisting with exercises;
  • Preparing the environment or equipment;
  • Moving the camera and changing focus; 
  • Assisting with technology
Or they might have a more passive role:
  • Helping to give or clarify instructions; 
  • Taking notes;
  • Providing reassurance and comfort;
  • Standby assistance for safety.

If the patient has another person present to hold the device and report any additional safety concerns it makes it much easier and more productive.

Physiotherapist, Neurology


  • Think about the supporter’s needs and abilities as well – don’t expect too much of them if they are less mobile or have a chronic health condition themselves.
  • Consider the carer’s wellbeing as well as the patient’s. You could use assessment tools for carer quality of life such as the Adult Carer Quality of Life (AC-QoL) questionnaire, or specific measures such as the Parkinson’s Disease-Carer (PDQ-C) questionnaire, which can be self-administered.
  • In certain situations, such as patients with severe physical, cognitive or communication impairments, consider involving a third person for further support – for example, they can control the camera while the primary carer focuses on the consultation.
  • Consider the patient-carer relationship and remember that this will vary between people and over time. Sometimes you might need to speak to the patient and their family member or carer independently. Keep the patient's needs and preferences in mind.