The Last Word: Remote Consultations

By Mr Sultan Hassan / 07 Apr 2016

Mr Sultan Hassan argues how remote consultations in cosmetic surgery can enhance a practice and improve patient satisfaction

The use of remote consultations in aesthetic practice is a relatively novel tool that has advantages as well as disadvantages. Some practitioners may be wary of adopting this technology, but I believe by having the relative safeguards in place, there is a role for this type of consultation in developing our growing practice. Since 2011, my practice has used remote consultations, whereby patients can be consulted via video call, instead of the traditional face-to-face visit in a practitioner’s office. As we are now seeing increasing numbers of patients seeking our services from across the UK and the world, having video consultations allows us to expand our patient base to help patients who may not have the time or resources to come into our clinic. It should be noted that although these are useful initial meetings between a practitioner and a remote patient, there needs to be a subsequent qualifying face-to-face meeting before any planned intervention. We do not advocate remote prescribing and fully support the current increased regulations to stop this poor practice in the industry. Approximately 10% of initial consultations at my practice now take place remotely using Skype and, occasionally, FaceTime. Skype allows me as a surgeon to share my screen with the patient and present diagrams and photographs, as well as surgically-important pointers, to help explain to the patient the reasons why a particular procedure may be preferable. We believe two-way video conferencing to be essential as this allows both the practitioner and patient to observe each other, use important visual cues to illustrate points and essentially have an almost normal conversation. Remote inspection-based examination of the patient’s area of concern has been used successfully for procedures as diverse as breast augmentation, arm-lift, liposuction and non-surgical treatments.

The benefits of remote consultations

In today’s busy society, initial remote consultations can be far more convenient than face-to-face consultations and still provide most of the benefits. A patient and indeed their practitioner can be in their own home surrounded by their family or by other members of their team respectively. In my opinion, one of the main advantages of remote consultations is the convenience to both patient and practitioner with the ease of evening video calls and other out-of-hours appointments. Another clear advantage of this technology I have found is that some patients find it easier to speak about their concerns without being in the same room as the practitioner. Being able to discuss this whilst in the comfort of their home is often easier for the patient.

Points to consider

Video calls are said to be relatively secure, however, there may be a question mark around just how secure they are. I advise both parties have up-to-date antivirus and malware protection that help avoid security breaches. It is also essential to have a good, stable wifi signal and not rely on 4G, as a poor signal can result in poor or delayed audio and poor quality video that can affect the quality of the consultation. Under these circumstances it may be necessary to reschedule until a better quality call is available. Alternatively, high-resolution static photographs can also be shared via screen share features, whereby programmes allow either party to share their screen with the other and observe their cursor, focusing attention on important aspects, just like a face-to-face consultation. Even though out-of-hours consultations are great for many patients, it can be detrimental to the consultant’s family life. To reduce the impact, at my surgery we offer just one weekday evening per week between 7-9pm for these types of consultations and an alternate Saturday morning. There is an important issue around chaperonage that should now be catered for to protect both parties during a remote consultation. Ultimately, in this age of increasing litigation and allegation, it is important to protect both parties from any doubt by having a chaperone present, albeit invited as an additional party to the remote meeting if not physically present at the practitioner’s location. At my practice we now also occasionally use remote consultations to help support patients in the post-operative recovery period; this can be essentially similar to a triage review. Emphasising massage method is easy to do over video or explaining correct positioning of a pressure garment, but practitioners must still be aware of when a patient needs to be directed to local medical services if there is clinical concern; if you are concerned about the possibility of any serious health risks or when the patient has expressed any concerns during the perioperative period. We always emphasise that remote consultations simply add a convenient assessment tool to our pre-cosmetic surgery evaluation pathway and is not a replacement of face-to-face consultations that must be completed before any intervention can proceed. All our patients are also advised that should any important issues come to light during subsequent face-to-face consultation, that were not apparent previously which may impact the surgery, then any planned surgery may need to be rescheduled to allow further consideration.

Conclusion

As part of our remote consultation process, our patients complete a medical questionnaire and we’ve received excellent feedback and satisfaction scores from these. We do, however, stress to patients who wish to have a video call as an initial consultation that they must have a subsequent face-to-face meeting if they intend to then proceed with a procedure. I believe remote consultations are here to stay, however patients should be asked to give informed consent for this type of consultation and it should be made clear that this forms part of a general consultation process to help assess and prepare them for a procedure. With appropriate precautions and security measures, remote consultations are an exciting development in aesthetic practice. 

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