Learning Outcomes

Explore how telehealth impacts the doctor patient consultation

Reflect on how the modality of video or phone impacts the consultation

Explore strategies for dealing with uncertainty in the telehealth consultation

Reflect on the role telehealth plays in longitudinal patient care

Session Outline

Pre-session reflective activity & references

The reflective activity focuses on how telehealth consultations differ from face-to-face consultations. Think about the techniques you use for each of these parts of a consultation. Record any key strategies, questions or comparisons that come to mind when you think about conducting a consult face to face, by phone or by video. The Reflection Activity can be downloaded from Session Resources.

Also ahead of the workshop look at the references for Session 2. The complete list of references can be found in the Session References section of this page.

Activity 1: Discussion (10 mins)

How does telehealth change the steps in a consultation? Share perspectives

Consider the key steps in a consultation and reflect on how telehealth may change this. The discussion should include safety-netting and follow up.

Activity 2: Case Study A + Discussion (15 mins)

Case A: A patient presents with a respiratory illness 

The purpose of this case is to explore how to assess an acutely unwell person over telehealth.

Questions for discussion:

What is clinically appropriate and not appropriate?
How does consulting via telehealth differ to a face-to-face consultation?

Case A Scenario

Carly is a 43-year-old mother of three who you see occasionally to help manage her minor illnesses and occasional flares of asthma that usually settle with salbutamol.  Her only regular medication is her combined oral contraceptive.  

Carly arranges a Telehealth phone consult with you, as she remembers that your practice prefers to initially consult patients over the phone if they are unwell with respiratory symptoms.  She has been unwell now for four days since returning from her cousin’s wedding.  Her symptoms started with a sore throat, fever and myalgias.  She developed a cough two days later which was initially dry, but she is coughing very frequently now and has some soreness generally across her chest.  She has developed some nasal congestion in the last 24 hours also.  She doesn’t feel breathless when resting, but she did try to go for a short walk with her husband last night and came home feeling exhausted and puffed.  This morning, she woke up feeling very fatigued.  

She’s taken a RAT test for COVID-19 on the day she became unwell which was negative.  She has tried her Ventolin puffer, but it doesn’t really help her cough.  

Activity 3: Case Study B + Discussion (15 mins)

Case B: A patient presents with abdominal pain

This case study explores issues around the need for examination and identifying red flags.

Questions for discussion:

Do I need to do an examination?
What safety netting do I need to do?

Case B Scenario

Jordan is a 24-year-old store manager who travelled to a music festival 3 days ago.  He has been to your practice once before 10 months ago for a respiratory illness.  You have little information about him, and this is your first consult with him. 

He booked a Telehealth phone consultation with you today as he has been unwell.  His symptoms started with vomiting during the four-hour car ride back from the festival 3 days ago and he is still not keeping food down and has lost his appetite.  He has had explosive diarrhoea with some blood and mucous in his stool for the last 2 days.  He feels weak and nauseous but has not had a fever.   He is drinking and passing urine normally and his girlfriend has bought some oral rehydration solution from the pharmacy.  He does have crampy abdominal pain in his right lower quadrant which can be severe, up to 7/10 at the worst.  It is often relieved by opening his bowels. 

He has called to arrange a medical certificate for work and plans to just rest at home.  His girlfriend who was with him at the music festival is not sick.  Nor are any of his close contacts.  He does not drive and has no close family in town.  His girlfriend had to go to work today and won’t be back until 5pm.  She is in phone contact with him. 

Activity 4: Case Study C + Discussion (10 mins)

Case C: A patient presents with a swollen knee

This case study explores whether video is more useful than phone in specific circumstances.

Questions for discussion:

What would video offer?
What other information can I gather and how?

Case C Scenario

Paul is a 74-year-old who lives alone. He’s one of your regulars and you usually see him every 3-4 months to help him manage his type 2 diabetes and hypertension. He is otherwise generally well.

Today, however, he has booked a Telehealth phone appointment with you. His left knee is swollen and sore and he thought talking to you by phone would be easier than seeing you in person.

He tells you, ‘Well doctor, my knee is sore when I walk and stand, it felt a bit niggly yesterday but this morning when I woke up it feels worse. It’s a lot puffier that usual. It hurts on the front, just under my kneecap. I wonder what I should do?’

You ask him some questions. He can’t really articulate the level of swelling; he keeps saying, ‘It just looks “puffy”’. He doesn’t think it is more red than usual. It hurts a bit to bend his knee, but he’s walking around the house, albeit with a slight limp. He doesn’t feel unwell and doesn’t think he’s had a fever. He tells you the rest of his left leg is not swollen, and his right leg looks normal. He’s speaking in complete sentences and doesn’t report any chest pain or shortness of breath. He hasn’t had any new injuries to his leg, and he knows how to check his skin for injuries and wounds because of his diabetes.