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Confrere is based in Oslo, Norway, where we work in close collaboration with professionals in Norwegian healthcare. Norwegian physicians have used Confrere for video appointments since 2017, and as of January 2019, Norway’s Directorate of eHealth and Directorate of Health have issued a report in support of the physician’s ability to use video calling, and mandating that all GPs adopt video appointments by 2021.
This report and conversations with our clients and Norway’s Health & Career Directorate have given us insight into when video appointments are suitable, and how they can fit into a physician’s practice.
Though much of our research is conducted in Norway, our findings are representative of how video appointments can be used in any country that supports telemedicine.
Video is no replacement for physical examination
Video appointments are by no means suitable if a physical examination is necessary, or if any tests must be done.
In which cases are video appointments suitable?
In the aforementioned report, the Norwegian Directorate of eHealth and Directorate of Health have summarized which cases may be particularly suitable for video appointments based on interviews with GPs and physicians who have experience with video appointments.
The Norwegian Association for General Practice (NFA) has been critical towards video appointments offered by private actors, but believe video to be useful in the GP’s practice, when the physician already has a relationship with the patient and their medical history.
Up to the physician’s discretion
The report emphasizes that it would not be appropriate to write lists of diagnoses and issues that should or should not be discussed via video appointment. The choice of the form that an appointment takes is therefore left to the physician’s discretion. We provide examples below of issues that may be well-suited for video. You can also read more about prudent practice and video appointments.
Follow-ups, guidance, and prevention
These are often the first types of video appointments that GPs try out. For example, they might hold an appointment in which they write a doctor’s note for a patient whom they know well, or hold a follow-up appointment with a university student who has just moved to another city. Guidance on things like diets and quitting smoking, as well as conversations with relatives of the patient, can also be done over video.
Petter Brelin, the leader of NFA, also emphasizes that follow-ups and guidance are particularly suitable for video appointments. At a conference on January 31, 2019, he highlighted examples such as follow-ups for COPD patients, and follow-ups of those on sick leave.
Prescriptions, medication, and side effects
These are examples of issues that may be relatively simple medically, but for which the patient could benefit from speaking with their doctor as they experience side effects from medication, or have questions related to changing or renewing prescriptions.
“Some patients may find it easier to open up and speaks freely over video,” explain physicians cited in the report. The option for a video appointment can also lower the threshold for reaching out to one’s GP. Ease of contact especially benefits those typically reluctant to contact their doctors, for example, young adults who are experiencing distress or symptoms of mental illness.
When a GP learns that a patient of theirs is in need of special care but doesn't reach out to get it, the doctor (according to Norwegian regulation) must initiate an offer for an appointment or home visit. In such cases, video appointments can be appropriate for establishing contact.
Poor general health, long commutes, or demanding life situation
For patients with a great need for follow-ups but for whom it is difficult to get to the doctor's office for various reasons, video appointments can ease the daily life of the patient and spare them the stress of traveling to the doctor's office.
Risk of infection
Patients with a contagious illness or infection, but who have a need for a doctor’s note, for instance, should rather make video appointment than visit the doctor’s office in-person so as to reduce the risk of infecting other patients and personnel.
Observing patients in their home environments
Sometimes it can provide more and better information to observe the patient in their home environment, like seeing a child in natural play. Some patients become stressed by the experience of being in the doctor's office, but are more relaxed when they can talk to the doctor from home or from a quiet room at work.
The report concludes that in some cases, simple assessments can be made in video appointments by observing certain factors, like respiratory rate, view of rash and swelling, and a patient’s report of quality and intensity of pain they’re experiencing.
As a replacement for phone calls
Something that was thought to be simple enough for a phone call might prove to be a bit more complex. In such situations, it can be beneficial to be able to look each other in the eye, and give the appointment a bit more time than a phone call usually offers.
As a replacement for written e-consultations
In a video appointment, both the doctor and the patient can easily ask follow-up questions. The non-verbal aspects, which are so important for good communication and relationship building between doctor and patient, also come forward.
Petter Brelin of NFA reports that Norwegian GPs don’t get much use from written e-consultations, mostly because they make it difficult to ask the right questions. They provide low diagnostic precision. GPs find single messages (e-messages) sent to patients both effective and useful, as they rarely involve an exchange of information, but rather function as instructions.
Collaboration and cooperation
The Norwegian Directorate of Health and the Directorate of eHealth foresee that video appointments can make it easier in the future to collaborate with other service providers and involve other parties, such as home care, hospitals, and the patient’s relatives in a patient’s treatment.
NFA also sees great potential for interdisciplinary collaboration. Actors involved with the patient can exchange information, and different departments of the health services can, with more ease and efficiency, assist one another. For example, home nurse and GP, or GP and specialist.
Estimates that 1 in 5 appointments can be done over video
In the report, it’s estimated that in the future, video consultations may constitute 15-20% of appointments in the GP’s practice. This is based on, among other things, in-depth interviews with GPs who use video appointments, as well as reported experience from Sweden, Denmark, and private actors.
Finding the best form for video appointments
The GPs interviewed in the report state that they experience video appointments to be a valuable option for both the doctor and the patient. They consider it most beneficial when they know the patient already, sharing the NFA's view.
It is a good principle to begin the appointment by clarifying for patients that they are able to speak freely about their challenges and concerns over video.
It’s useful to end the appointment with summarizing questions, like whether the patient has something they want to add or whether there are other things that the patient thinks may be of importance.