In recent days there have been discussions as to the value of telephone consultation in primary care. Let me add to the discussion with an account of my experience. In the early days of developing Rheumatology Toolbox we used another strategy to try and reduce the workload in Rheumatology outpatient clinic. By workload I mean the time and effort involved in attending a rheumatology clinic this included time off work, travel time, carbon footprint and the cost in time and effort for the accompanying persons.

We set up a small study comparing the quality and quantity of clinical data obtained via an online system and the direct face-to-face consultation. The quality of the information using the two methods was broadly comparable, our study concluded that one could get very useful information via telemedicine.  This of course is in keeping with other findings that up to 70 or 80% of diagnostically useful information is obtained by talking to the patient the implication being that physical examination will provide a lesser amount of clinically useful information. Clearly physical examination often confirms the clinicians impression following the questioning of the patient. This stands to reason, the patient is the best witness of their own illness over time, the clinicians skill is essentially in distilling this information, gleaning it from the patient and formulating a diagnostic hypothesis.

At the end of our study we concluded that telemedicine in the form of a video consultation was most useful in seeing patients for review after their initial consultation had been done face-to-face in a conventional clinical setting. Subsequently we set up a very useful rheumatology telemedicine clinic that was well received by the patients and clinicians.

We are in the early phases of planning the bottom webinar programme. There will be new topics and we will revisit some previous topics that have been requested. The “Tools for you” instruction videos that we have uploaded on YouTube have proven very popular,This autumn we intend to do a similar instructional video for patients with gout.

We are on the last week of the Spring Series of Rheumatology Toolbox Webinars. In this week’s Webinar we will deal with lesions of the Foot and Ankle that are commonly encountered in primary care, and we will introduce more “Tools for You” to assist patient education/management. Tell your friends/trainees/colleagues.

Register through the following link: https://rheumatologytoolbox.com/registration/Registration

This evening we have the penultimate in the spring series, to date it has been very well attended. There is exceptional interest in tonight’s topic, skin cancer and Hidradenitis suppurativa.

We will welcome many of those who have attended webinars the past and we expect some new visitors. There has been increased interest in our webinars in other countries. Quality of presentation, relevance to primary-care and ease of access all contribute to our success thus far.

THERE ARE A NUMBER OF ELEMENTS TO ANY PROBLEM

THERE IS EXCESSIVE UNREGULATED INFLOW

THERE ARE BLOCKS TO THROUGHPUT

DIVERSIONS OF FLOW ARE OPTIONS

A PROBLEM IS BEST RESOLVED BIT BY BIT

THERE IS NO PUBLIC FORUM TO ADVANCE OUR UNDERSTANDING OF THE PROBLEM. MAKE YOUR SUGGESTIONS.

Two years ago at the Irish healthcare awards in 2013 John Carey and I were involved with colleagues from Roscommon. We received an award for setting up a Telemedicine service for rheumatology patients in the Roscommon area. In spite of its success as a service for patients it has not been extended in rheumatology nor have other services used to the template for delivering a clinical service to areas remote from the hospital.

I recently came across a presentation from the Mayo Clinic on YouTube extolling the virtues of telemedicine in primary care. And the experience recounted in that presentation is very much my own.
An article in January by Skip Fleshman in Forbes / Pharma & Healthcare entitled “Why Telemedicine’s Time Has Finally Come” suggested a combination of factors are driving this growth, profit, technology and convenience are all playing a part. Oh! And patient acceptance. He predicts it is going to be the biggest trend in digital health.
In September the American College of Physicians produced a position paper “Policy Recommendations to Guide the Use of Telemedicine in Primary Care Settings” in it they deal with issues such as the physician- patient relationship online and in office. They advocate that the patient and the physician should have a real ongoing doctor-patient relationship. They warn against “one off” encounters that would lack that depth.
We started off four years ago developing a telemedicine service in the West of Ireland to deliver rheumatology expertise to patients close to their community. The service was effective, accepted, efficient and cost/time saving.

I can see potential for a telemedicine service to extend specialist medical care to remoter parts of the country. (in the case of ”National Services” that means outside the Pale).

It could be a suitable way for family doctors to link with their patients at a time that is convenient. Maybe sometimes to work from home.

Telemedicine can link nursing homes or homes for the elderly to specialist services in hospital thereby avoiding the need for the patient to travel to the OPD or A&E. This may reduce the demand on trollies.

Indeed one could see a potential for A&E services to be rolled out from their “centres of excellence” to the community thus avoiding many unnecessary wasteful and expensive trips to the hospital.

To date what has happened in Roscommon has stayed in Roscommon.