Sports and exercise podiatry unmuted: telehealth is an opportunity to show value

The sudden switch to telehealth patient consultations due to COVID-19 provided a challenge for a profession with human contact at its core. The lessons learned demonstrate the opportunities for podiatrists.

Measures designed at containing the spread of the Coronavirus (COVID-19) pandemic prompted an almost overnight change from seeing patients in-person to using phone and video conferencing platforms. Beyond emergency interventions and care for patients with serious problems that would escalate without our care, face-to-face contact was restricted, leaving thousands of allied health professionals, including podiatrists, wondering how they would provide patient care. 

Rather than seeing the use of telehealth as a necessary means of keeping their practices afloat, some, like John Osborne from Bounce Health Group and Mulgrave Podiatry in Melbourne, saw it as an opportunity to refine their systems and think about how they could offer a more valuable service to patients.

“I was fortunate to be in the position where I like using new technology, and I’ve been working with elite athletes who travelled frequently,” Osborne says, reflecting on the steep learning curve telehealth presented. 

“These were known patients [elite athletes] and who’d been set up to go away, and I’d check in with them regularly. With COVID, I had new patients, and I didn’t have their background, and some had never seen a podiatrist before. I had to very quickly find ways to integrate various bits of technology to provide the same level of service and treatment that would normally happen face-to-face.” 

Systems and structure 

It wasn’t simply a case of sending Zoom meeting links, Osborne says. Making it all work – and he readily calls it a ‘work in progress’ – needs to be well thought through.

“When it’s thought of as just a bolt-on and rushed, it puts a lot of stress on your admin staff, the clinician and the patients. 

“From a patient booking online, to integrating the practice management systems, sending booking links, being able to send booking reminders, all of that needs to be ironed out, and if possible, automated or it can simply overwhelm the practice and the patient. It just becomes too hard.”

Osborne says a streamlined practice management system is vital for the patients, who are not only dealing with telehealth for the first time, they may also be unfamiliar with videoconferencing tools. Or at the other end of the scale, are simply overwhelmed with the experience of spending so much of their lives online. 

Patient education

To smooth out the patient experience and to be able to provide a level of service they expect, Osborne emphasises the need for patient education. 

As part of the booking, the patient would be sent links to YouTube videos to help them prepare for the consult. The videos covered a host of practical information, such as where to position their device, what objects to have handy or cleared away, what happens during a consultation and what to expect generally; information all aimed at instilling confidence in the patient. 

“The challenge is getting them on board on first place,” Osborne says. “But once they’re on board, patients have told me they found the experience incredibly beneficial and quickly booked a follow-up appointment.” 

While the obvious drawback is the limitations on mechanical diagnoses and treatment, Osborne says the treatment can become more relevant when the patient is in their own home. 

“I had a patient who did rehab on her Achilles at home throughout COVID. From a strength and rehabilitation perspective, being limited to using what she had in the house, as opposed to having her at my gym in the clinic, meant she was learning and doing the exercises that were more relevant to her treatment.”

“A lot of podiatrists might have been uncomfortable with the change and felt that the only way to use telehealth effectively was exercise prescription, when really it’s an opportunity for patient education.” 

Mindset

A key to being able to adapt to the new way of working with patients comes down to mindset.
An obvious challenge in the telehealth domain is not being able to get “hands-on” with the patient, particularly during diagnoses, and feeling restricted or limited in accurately diagnosing and treating the issue.
 
“In many cases, what you’re trying to do is guide a patient through a process of self-assessment,” Osborne says. “That’s empowering for the patient, but it can be confronting for a clinician because you have to change your perspective on where your value lies.”
 
Osborne says this process highlights the value of the relationship with the patient. Taking the time to talk to the patient in greater detail can reveal a more holistic picture of their issues and become critical in making accurate diagnoses. 
 
“If something’s a bit unclear, you might be more likely to use an imaging type perspective to try and help guide your process, but imaging has its own issues. 
 
“Sometimes, it’s as simple as talking a patient through their whole story. I often talk about patients having a story or their problem having a story. And finding where the elements of that story are, is important.”
 
Despite the challenges and imperfections in implementing and continually improving how telehealth is delivered, Osborne says podiatrists have an opportunity to embrace change, and by providing value to patients, the profession as a whole will benefit.
 
“This is really about holding ourselves accountable and responsible for having the best understanding of the foot and ankle. Embrace telehealth, learn everything you can about the foot and how you can deliver on that platform. 
 
“If we are going to shy away from challenges like telehealth, we’ll be stuck cutting toenails.” 
 

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