Table 1

The seven Ps for a successful virtual clinic

PracticeEnsure familiarity with the system, both the clinical applications and communication tools, especially if working off-site in advance of your first clinic. Check audiovisual equipment is working before initiating any consultations.
Patient- centredDecide whether the consultation will be audio only or with video conferencing, and send information/instructions in advance about what to expect from the consultation (including the time, date and duration).
Confirm that the patent is able to speak confidentially and that they are comfortable using the technology/device chosen for their consultation.
ProfessionalFind a suitable quiet space (particularly if consulting from home) to avoid disturbances and maintain patient confidentiality. If examination is absolutely necessary (either live video or via picture messaging) explain the need clearly, recheck consent and preserve dignity. Be aware that some applications (including the patient’s) may allow the recording of consultations.
Plan and prepareReview the patient’s file in detail before the consultation to anticipate issues including any difficult discussions or language barriers (although it may be possible to include an interpreter in a three-way call). It may be necessary to make alternative arrangements, including changing to an ‘in-person’ consultation depending on circumstance.
Perform the consultationDevise methods of denoting that a patient is about to be contacted by you to avoid two clinicians in the same virtual clinic ringing the same patient.
Set expectations with the patient at the start of the consultation.
Headphones are helpful to avoid feedback. A screen-sharing option is useful to show scans.
Decide how many times to call the patient if unable to connect first time and consider options for leaving a message on an answerphone. In particular, avoid identifiable or sensitive information if the answerphone is not personalised (and therefore the possibility of a wrong number).
PerfectIt takes time to learn how to set up a virtual clinic and do it well; consultations early in the learning curve are likely to take longer than with experience. Perfect methods of eliciting patients’ ideas, concerns and expectations and methods to summarise the plan and draw the consultation to a close.
Reflect on the process and get feedback from colleagues and patients to improve the process in the future.
PrecisionDocument the consultation in equivalent fashion to an ‘in-person’ consultation including letter dictation and arranging follow-up tests/appointments. State that the consultation occurred remotely and explain why.