Although I sometimes flatter myself that patients actually look forward to seeing me for their appointments, the reality is that for most, attending doctor appointments can be a bit of a chore.
Medical appointments themselves don’t take that long but the process of getting there often does. There’s the time off work or childcare to consider, finding a hospital car parking space, or the demands of negotiating a journey with the additional demands of the symptoms of a chronic illness. The consolation of a waiting room which allows unlimited access to vintage copies of Hello magazine or Homes and Gardens isn’t always enough…
Thats why I was fascinated to demo a system that might allow patients to experience the benefits of a medical consultation, from the comfort of their own home or workplace.
Facetalk is a new, secure, hi definition video consultation system developed by the Radboud REshape & Innovation Center the Netherlands. The Facetalk tagline is ’Your Virtual Consultation Room’.
Lucien Engelen, the director of the centre showed me how it worked.
Our ‘appointment’ took place during the evening when I was at home and Lucien (whom I expect works longer hours than most doctors) was still at work. The email invitation I received to the appointment included a link which prompted me to download a piece of software to my iPad (the platform can be viewed on PC, Mac, iPad, iPhone and Android).
Once installed (pausing only briefly to settle an argument between two of my kids and put the rubbish out), I was then ready to ‘attend’.
And there was Lucien. All three of him. In order to show me how easy it was to have a number of people connected simultaneously, Lucien had connected toFacetalk using three devices simultaneously; his PC, iPadmini and iPhone. Lucien, as the “doctor” in the consultation, was able to share his desktop with me show me xray, clinical images or videos (in hi definition). He explained how up to 10 people can attend a meeting simultaneously (eg a patient, attendee of their choice, GP, Hospital doctor physiotherapist etc). A hard feat to pull off in real life in a busy outpatient clinic.
I was able to attend my meeting with Lucien from my office but also – because I was using a tablet device – from my kitchen or even (theoretically, but lets not go there) my downstairs toilet.
Facetalk has already been piloted to facilitate a diagnosis of skin cancer, out patient neurology appointments, paediatric urology consultations, palliative care consultations, TPN prescribing and and cleft palate.
The advantages of Facetalk are, according to Lucien, that it is secure (neither Skype nor Google Hangouts are secure for Healthcare use), doesn’t require any fancy hardware, works on all systems (except Blackberry), and that is does not require Flash (use of Flash video can pose additional security issues – not to mention, viewing problems on Apple mobile devices). Facetalk has also incorporated a workflow solution for healthcare without the additional hassle of security codes and does not require registration at the patients’ end.
It works over a regular home broadband connection and also works over 3G connections (think ‘Youtube’ over 3G).
I think it is likely that Facetalk will also add value for doctors. It will allow us to collaborate with specialists without the need for travel, might reduce the amount of time necessary for a consultation, and potentially reduce the need for office space and secretarial staff where there are less patients are physically present.
I’m decided to offer it to a group of my patients who are interested in using it in place of their regular appointment. I feel its probably going to lend itself better to patients who I know reasonably well, who have conditions where perhaps a thorough physical examination may not be necessary on every visit; eg Ankylosing Spondylitis, stable psoriatic arthritis or fibromyalgia. I’ll let you know how I get on.
Would anyone like to buy some old copies of Hello magazine?
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Brilliant! That you even put yourself in the position of your patients to see how they feel is amazing. Too many doctors don’t seem to care. It would be so helpful to remove the stress of getting to those follow up appointments that some patients drive hours to get to only to spend more hours in waiting rooms. Hail to you for making it easier on your patients. Now, will you be my doctor? :-)
The idea of a Virtual Doctor is unique and bizarre. I have been that patient in various waiting rooms i.e gp and hospital clinics. In my career as as dental nurse, I experienced the other side of the coin for example being asked “How long more must I wait, my apt was ten minutes ago” .
Now my waiting room did have up to date magazines. My boss was and is still a very dedicated Dentist.
However, I for one prefer face to face consultations with both my gp and consultants. It isnt always easy with a serious illness and working to get time off but it is important to me to talk face to face with whoever is treating me. I do realise, that in the hospital side of things, I am just a file with a number along with every other patient. In fact I am a huge file at this stage!!!!! I certainly wouldnt want to reduce to a tablet. My consultant is extremely hard working between a few hospitals and it certainly wouldnt be fair to him to take up his family time with a virtual consultation over the dinner table. But I wish you well with your endeavour
Thanks Joan. I guess the mistake here would be to assume that its going to suit everybody. Its certainly not going to remove the need for physical meetings altogether. I’m really putting feeler out to see if patients would like to use it on the assumption that the whole process of travelling for an appointment is a big deal. Maybe its not as big as I think it is or maybe the hassle is worth the one to one intimacy of a face to face consultation in real life. I look forward to hearing from my patients in the coming weeks to see what they think.
Hi Ronan
I do use tele heath videoconsultation for my patients who live remotely. As the specialist, I’ve connected with GP practices where the patient is in attendance with a nurse or the GP, and also with the patient directly.
I have used a variety of platforms including Cisco Webex, Logitech Lifesize, etc. It’s been dependent on what the GP clinic end has set up. I’ve even worked with a GP who has a dedicated telemedicine cart (http://www.telemedicineaustralia.com.au).
By and large, the simplest option has been Skype. It’s ubiquitous and works quickly. Patients can very easily set it up at home or already have it. The privacy issue is probably little different from a conversation on the phone which is already being done all the time.
The biggest problem by far is the fact, as rheumatologists, we do like & need to examine the patient so choosing when videoconsultation is appropriate is important. Or at least, patients need to understand that there are times they need to attend in person (and they do).
Thanks Irwin. You are the rheumatologist with the most experience in this area that I know, and I really value your input. I’d like to pilot it for a select number of patients where perhaps physical exam isn’t important every time we see them. I think it would be icky to use for rheumatoid therefore where I like to examine patients every visit. I’ll let you know how I get on. Perhaps we’re being to picky being wary about using Skype..
Good morning Ronan I think it is a good ideas for certain patients obviously with knowledge of the patients usual needs. Would these consultation be incorporated into the normal office hours.where facilities such as secretarial support and the required telecommunications facilities such ad the required sending of prescription and X-ray requests. Or are these consultations planned in the evening when patients are conveniently at home after their days work and you then complete all the follow up details at the start of your own busy day at the office. How will cost of consultations be addressed?
Thanks Trish. I’d be keen to pilot this during working hours but perhaps dedicate a few slots outside regular clinic times. The issue of how the appointments are paid for is important. Where patients would usually be expected to pay for their appointment on the same day, we can receive payment electronically via Paypal.
Ronan,
This really looks fascinating and as more and more people become used to communicating through Skype etc its seems likely to catch on. I can see the need for initial face to face meetings and perhaps scheduled follow up but imagine that many routine appointments and therapy sessions could be delivered this way. I wonder though have people found it difficult to maintain a good connection with the patient over a sustained period of time ? I imagine it could be easier to ‘not really present’ when using FaceTalk vs when physically sitting opposite your patient ?
Thanks Margaret. I’m thinking that alternate appointments for existing / previously seen patients would work best. Regarding the possiblity of ‘not being there’, its possible but as the doctor is on screen, it will be obvious (as that is the only filed of view), if they are doing other things. Lets see. I’ll be asking for feedback from patients to see what they think.