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 primary care physicians 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 PCPs 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 PCP’s practice, when the physician already has a relationship with the patient and their medical history.
At 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 PCPs 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 patient who has just moved to another city to attend university. Guidance on things like diets and quitting smoking, as well as conversations with relatives of the patient, can also be done over video.
Prescriptions and medication
Perhaps a patient has questions regarding a new prescription or needs a regular one refilled. Maybe you need to follow-up about a medication that has low-risk side-effects. Video appointments are useful for issues that are simple and low-risk, but for which the patient would benefit from speaking directly with their doctor.
“Some patients may find it easier to open up and speaks freely over video,” explains one physician cited in the report. The option for a video appointment can lower a patient’s threshold for reaching out to their doctor. Ease of contact especially benefits those experiencing mental illness or other difficulties that may increase a reluctance to seek help.
When a PCP 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 who need many follow-up appointments - patients undergoing cancer treatment, for example - follow-ups over video can ease their daily life. This is especially true for patients who have to pass several hurdles to get to the doctor’s office, like a long commute, being a parent of young children, or suffering from poor general health.
Risk of infection
When a patient has a contagious illness but needs a doctor’s note, a video appointment will prevent them from infecting other patients and personnel during an in-person appointment.
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.
NFA reports that Norwegian PCPs 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. PCPs 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
As video appointments become integrated into the healthcare system, they will make it easier 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 PCP, or PCP 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 PCP’s practice. This is based on, among other things, in-depth interviews with PCPs who use video appointments, as well as reported experience from Sweden, Denmark, and private actors.
Finding the best form for video appointments
The PCPs 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.