An Experience With Telehealth
Dr. Louise Bibby (Osteopath)
- April 4th, 2020 -
Swan Hill, Victoria, Australia
I’ve had a brilliant week of official Telehealth consults through Cliniko, but when I think about it, I have already been doing “Telehealth” over the phone for 10 years in country Victoria unknowingly, and for FREE! The only difference is now I am recognising the value I have been giving to patients all these years, who have previously had difficulty in accessing services due to locality or my availability. I am thoroughly enjoying adding the “Telehealth Challenge” to the list of services and skills my team and I can provide as practitioners for our valued new and long-term patients
For now we are working harder than ever for our patients (for a lesser fee), but eventually Telehealth will be a regular service in our clinic for the longer term (possibly even for a similar standard fee) that patients can CHOOSE to access. The same amount of time and effort goes into the actual Telehealth consult and in writing up rehabilitation plans etc. It can also be the preferred option for rural and remote patients who sometimes travel up to 2 hours to receive hands-on care or general advice. This is sometimes the same with patients who travel into metropolitan regions or over many suburbs in a big city.
My biggest learning curve and advice? Don’t assume patients won’t like Telehealth. Don’t assume they won’t want to pay for it. These things are not your concern. Also, don’t make the assumption your patient does not want their practitioner to take it to the next level, and offer an advanced rehabilitation goal, plan or challenge during this time - with a massive smile on their face.
You must think what your overall recommended rehabilitation goal is - STICK TO IT - and assess how you can pack incredible VALUE around your delivery to get your patients on the same page as you, and let them know they will be thoroughly cared for, supported and monitored. There is incredible value in an osteopaths brilliant mind, and the way they can educate a patient, at any age or ability.
An overwhelming sense of support and generosity to your very important people during this time is something that they will always remember, and be impressed by, making them feel highly valued by the way you go above and beyond to create this service. It certainly has improved patient connections and relationships in our clinic so far. Every time they advance book their next Telehealth, hopefully by then you can see them face-to-face.
So what now?
If you just think Telehealth looks like “taking money off people for a sub-optimal service” then perhaps the way you progressively challenge your patients through “phases” of rehab (once you’ve used your incredible hands) may not be your strong point. All the stuff the patient does to NOT rely on your hands. If they’re still doing bridges and clams, and have been doing so for the last 6 months, you can certainly move past this point.
Now is the perfect time to get your non-compliant patients, or those you’ve never challenged, to be proactive. “It may be a little while before I can see you again in person, but I would like to see you achieve… xyz, and I need to teach you.. xyz.”.
Some self-therapy, some mobility, some neuromuscular activation and strength. Yep, you have to jump around like a circus clown with all the pretty gear you have in your rehab cupboards. That is what it is for. If you don’t know how to use it, you have time to learn, or reach out for support. We have plenty of great resources within our profession, and allied health friends who do exceptionally well in this space.
There are so many levels that can be achieved with rehabilitation. Aaaaand I’m also sorry - you have to be able to practice what you preach, being competent at activity yourself. (Eg. Advanced shoulder taps in high plank position that challenge anti-rotation and truck stability - for running patients with lateral hip pain and stability issues, or ones at an advanced level of lumbar disc injury rehabilitation.)
We learnt “osteopathy” at university, not “advanced exercise rehabilitation”. It’s a tool you need to continually learn and develop over time - beginner, through intermediate, to advanced - and can be applied to most injuries. Simple exercises, once the patient adapts to, can be progressed to enhance the demand on the associated tissues and structures, and further adaptations can be achieved - monitored closely of course.
What does the future look like?
I assume the short-term future will look very different, and that adapting to change will be vital for all of us. Telehealth for us it not a downsize in our service, it is an advancement in the unique way we can connect with our patients, and continue the investment patients have already put into their health and rehabilitation with us. It gives us a chance to promote and enhance their goals, programs and plans, and ensure that they too are moving forward during this time.
If you’re not moving forwards, you’re moving backwards. It could be a really long time until we practice “as normal” without restrictions, so having another option is a good idea before patients fall off the radar completely. Be proactive! In the future, you then have two ways in which you can see patients, even if they are stuck on their couch and can’t move, or they’re having an emergency on holidays.
Using Telehealth, you can achieve some safe assessment (yes, you are limited, bit think outside the square), self-care, and exercise prescription for short-term relief of pain and discomfort as a minimum (NOTE: Being as safe as you would with any working diagnosis and advice). By the time you courtesy call in a few days time, some tissue healing may or may not have occurred, they may or may not be well on their way to improving, and the things they’ve tried may or may not help you confirm your diagnosis. You can make the next plan.
YES - we sometimes NEED to use our hands to find a more accurate diagnosis for a more complex condition, and YES - we LOVE using our hands to improve patients. However, it’s not ALL rocket science. A majority of the reasons why patients see us is because they’ve injured themselves acutely, or they are the product of a poor lifestyle, their environment, habits and behaviours, or poor tissue tolerance - this, you can help with immediately.
You don’t always have to put everything back in place, square this, balance that or release here and there to, 1. Get approval. 2. Trust that your patients can do more than they usually do to help build a body that is resilient and more tolerant to pain.
Giving their aches, whinges and “pains in the a**e” something “productive to do” - sometimes this can be enough to derail or distract from a sticky situation.
Change nothing, and nothing changes. If you’ve never tried to fix pain without your hands, or trusted the patient can chip away at guided self-therapy, you’ve never truly experienced the joy of teaching patients to be self-caring, or how happy they are when the realise they have had the tools all along. They appreciate this more than anything. There are lots of tools to help you do this, and it may involve an open mind and navigating territory unfamiliar and unchartered.
Side Notes:
Love to all during this difficult and uncertain time. I am happy to answer any questions, but I don’t have all the answers, just sharing my experience and ideas. Sorry if I have offended anyone unknowingly. We all practice in different ways, which is the beauty of our profession, and we still have a lot we can teach each other in an evolving practice.
I LOVE that we also have some advanced hands-on practitioners, that can work wonders with their hands in ways others cannot.
I understand that some practitioners work almost 100% just with their hands. Cranial, paeds, kids, some certain patients etc that directly require hands on care. Telehealth may not always have the solutions for you.
I understand this may work more effectively in rural regions where access to services and travel is usually a barrier.
I understand this may all be temporary, or that success with Telehealth may come and go.
I understand that osteopathy and this situation we are in varies from country to country, practice to practice.
I understand there are limitations to the the virtual world, but I spent time teaching an 85 year old how to use FaceTime this week. He cried, and immediately went and called his kids via video link. MEANINGFUL IMPACT.
I understand patients can’t claim on private health, but if they’re not making appointments or cancelling because they can’t get their “usual hands on care that they rely on”, you perhaps may not have truly informed them how half an hour of education, coaching, mentoring, and advanced self-care and rehabilitation could ACTUALLY be the most beneficial thing they can do for themselves to move forward - and you must ACTUALLY deliver for the value.
Disclaimer: I do not work for, or actively promote for, Cliniko or Physitrack, but they have been very helpful this week.