Top 10 tips for successful GP video consultations
Publication date: 02 April 2020
Many GPs and most patients will have little previous experience of consulting remotely by video link or smartphone. Using an unfamiliar format at a time of high workload and high anxiety increases the risk of making errors of judgement, but this risk can be reduced by paying attention to some basic principles.
1. Role of video consulting
The patient’s safety must always be your top priority. Don’t be seduced into thinking that every problem can be dealt with remotely. If you need to examine the patient, you need to examine the patient.
As well as your clinical competence, patients who are sick or worried also need to feel understood and cared about. The way you consult by video can go a long way towards reassuring the patient that they are in safe hands.
If you are setting up a video consulting service for the first time, see whether it is possible to give patients some prior information about what to expect, including:
- when and how to establish the video connection;
- any types of problem that are unsuitable for remote consulting, e.g. those clearly requiring a physical examination;
- any details of their problem which the doctor could be told about in advance.
3. Setting up
Location - If you are working from home, choose a neutral setting and background so that the patient is not distracted by glimpses of your domestic circumstances.
Dress professionally - at least, the visible parts of you!
Privacy - Make sure you will not be interrupted, and that background sounds are not intrusive.
Framing - I think landscape format is better than portrait. Landscape feels more natural, and gives a feeling of a comfortable separation between you and the patient; portrait view can feel too much ‘in your face’. Adjust your position so that your head is central in the patient’s view. The patient should be able to see your facial expression without straining, and preferably also your hands, as hand gestures are an important part of communication.
Lighting - Make sure your face is well lit, and avoid having a source of bright light behind you.
Make sure you are familiar with how to adjust picture quality and sound level on your own equipment, and if possible how to help the patient optimise their own settings.
With some video platforms, or if bandwidth is an issue, there may be a small time delay in the system, or picture and sound may be out of synch, or the picture may periodically 'freeze'. Be aware of the danger of missing significant information because of these distractions.
Introduce yourself, and tell the patient what you would like them to call you.
If you don't know the patient, confirm whom you are talking to. If it's not the patient, remember there may be issues of confidentiality.
Ask the patient what they would like you to call them.
6. 'Pacing cues'
Pacing cues are the verbal and non-verbal signals we give when conversing that regulate the alternation of each person’s contribution, and that show we are listening or wanting to interrupt. They include nods, facial expressions, noises like ‘uh-huh’ or ‘mmm’, and words like ‘right’ or ‘OK’.
On a video link, these cues may not have their usual effect. Visual cues may be harder to see on screen. The other person’s speech over the link may not be as loud or as distinct as we are used to. If there is even a slight time lag between vision and sound, our ‘uh-huh’s and ‘mmm’s may become distracting interruptions. To minimise the effect of these problems:
- Try to make sure only one person is talking at a time.
- Keep your vocal cues to a minimum – a slow nod or a smile is better.
- Show your interest and attentiveness by eye contact and facial expression
- If you need to interrupt the patient, try a visual signal such as raising your hand
- Rapid gestures or body movements can be distracting – try to slow them down.
7. Eye contact
If you want to make eye contact with the patient, remember to look at the webcam, not at the image of the patient’s face on the screen.
In the unfamiliar circumstances of a video consultation, it helps the patient if you ‘signpost’, i.e. tell the patient what you want to do or say next, and why. E.g. ‘Now I’d like to ask you some questions to see if this could be anything serious.’
9. Check for understanding
Before finishing, summarise the consultation’s main points, and ask the patient if they have any questions, or if there is anything they would like you to explain again. Allow time for them to think before they answer.
10. Closing the consultation
Safety-netting is particularly important when you have not been able to examine the patient. Be explicit about what the patient is to expect, what to look out for that would suggest a need to consult again, and what they should do in that event.
End with a friendly sign-off, e.g. ‘I’ve enjoyed talking with you. I hope that’s been helpful.’
Because of the greater uncertainty in remote consultations, detailed note-keeping is essential, including a note of your advice and safety-netting measures.
Video consulting, especially from home, can be lonely. Make sure you have the opportunity for a regular ‘debrief’ with a colleague, where you can discuss clinical matters and also any feelings of stress or concern you may be experiencing.
- Top 10 tips for telephone consultations - blog post from Roger Neighbour
- Triage and new ways of consulting resources on the RCGP COVID-19 resource hub
About the writer
Dr Roger Neighbour is the author of The Inner Consultation (1987), The Inner Apprentice (1992), and The Inner Physician (2016). In 2003 he was elected President of the RCGP for a three-year term. Now retired from clinical practice, Roger lectures and teaches widely in the UK and abroad on consulting skills and general practice. In 2011 he was made an OBE for services to medical education.