Session 4
Consultation Challenges
Table of Contents
Learning Outcomes
Explore clinical decision making in the context of telehealth consultations
Identify boundaries and comfort level regarding different patient presentations and how that impacts telehealth
Identify strategies and skills to enhance patient safety when using telehealth
Session Outline
Pre-session references
Ahead of the workshop look at the pre-session references for Session 4. The complete list of references can be found in the Session References section of this page.
Activity 1: Discussion in pairs (5 mins)
What have I changed about my telehealth consulting recently?
This brief sharing reinforces the learning from previous sessions and is a way to normalise that we are improving our practice all the time. Keep the conversation brief and practical.
Activity 2: Rapid Fire Cases (30 mins)
Rapid Fire Cases
This activity is a rapid-fire game that gives players the opportunity to learn from their colleagues about tips, tricks and strategies to better manage telehealth consultations and ensure patient safety in a solution focused way.
We have designed a simple one-page document with two types of scenarios that can be cut up into simple cards. One side contains clinical scenarios. The other side has telehealth specific scenarios. Print the page and cut the scenarios up and place them into two piles – one with clinical cards and the other with telehealth cards.
One participant chooses one clinical scenario and one telehealth scenario and reads it aloud. The aim is for each player (or pair of players) to share what they would do in the scenario. To cover multiple cases rapidly to make it more fun we recommend setting a timer and moving through to a new case each 5 minutes. Please assume that the patient is well known to yourself unless otherwise stated.
Activity 3: Case Study A + Discussion (10 mins)
Case A: The sick child
The purpose of this case is to explore the challenges around assessing children via telehealth.
Questions for discussion:
How does our practice manage fit-ins, follow-up and reviews?
How do we plan for when things go wrong?
Case A Scenario
You are settling into your new practice, and you are filling in some of the gaps in your day with Telehealth appointments while you build your patient base.
Your next Telehealth appointment is with Lucy, the mother of Joseph, an 18-month-old who your colleague saw in person two days ago. Your colleague asked mum to book a Telehealth today in case he was still unwell. That colleague works part-time and can’t directly follow up.
You see in the notes that two days ago the child was feverish, lethargic, and quite unwell with a cough the previous night. He was off his food but drinking OK. Mum's worried about him today, it's now 6 days of fevers in this illness and things have not really improved. He's still grisly at night, waking frequently, but is eating more. There is a rash now on his torso. He drinks well, producing normal numbers of wet nappies and doesn't seem affected by bright light. He's subdued but cranky when he is awake and is consolable.
Mum is home alone with him. Dad is at work and has the car, so they can't easily come in for a physical exam. Mum wants to know how to manage the situation.
Activity 4: Case Study B + Discussion (5 mins)
Case B: An urgent referral
This case study focuses on non-urgent administrative issues in a consultation for a child patient.
Questions for discussion:
What are my thoughts on this case?
Case B Scenario
Josie, mum of 5-year-old Ava, has booked Telehealth in her daughter's name.
Ava has learning difficulties and developmental delays that are under investigation.
Josie and the family are in Sydney for a second visit with a developmental paediatrician.
Josie has just realized that she needs a new referral. They are seeing the paediatrician later today.
Josie has a list of new concerns, including a series of new behaviours that she's noticed in Ava. Some of these seem unusual. Josie sounds very stressed and you realise that writing this referral is going to take some time.
Your usual practice would be to first see Josie with Ava face to face to do a thorough physical assessment of these new issues.
You voice this to Josie, but she says:
"Well, Ava is just here with me, isn't that enough? Please, I'm desperate!"
Activity 5: Discussion (10 mins)
Wrap-up
Identify one thing I will keep doing
Identify one thing that I might change
Post-session reading
The post-session reading is the Session 4 Key Learning Summary. Please download resources below in Session Resources.