Love them or hate them, it’s time to embrace them. Virtual appointments might be here to stay.

Canadians owe Dr. Maxwell House, of Newfoundland and Labrador, a debt of gratitude for pioneering the development of virtual care (telemedicine) in the 1970s – especially in light of the pandemic.

House wanted to find a way to provide the same care to those living in Newfoundland’s remote locations as to those in urban environments. Using the technology of its day, which included satellites to connect televisions and telephones, telemedicine provided the much-needed platform for both medical diagnostic and consultation activities. 

Fast forward to today, COVID-19 has pushed the boundaries of that virtual experience, and it is not uncommon now for Canadians to seek out virtual appointments instead of having to schedule a personal visit with their healthcare provider. 

There is no question the early stages had some hurdles to overcome, and some remain. But overall, virtual care has been an eyeopener for practitioners and patients alike.

“There are some limitations for sure,” points out Dr. Ira Smith, Sports Medicine Physician and the Physician Lead of Sports Health at Cleveland Clinic Canada.  “But there is always the option to triage appointments. That’s what we did in the early stages of COVID-19. We wanted to ensure those who required essential care could come in as those were our restrictions at the time.”

Today, explains Dr. Smith, in-patient care is still offered. However, patients can also combine their visit with a virtual experience. In most cases, there is no difference. Physicians have to talk the patient through their examination – like asking them to put their arms here and push on this and tell them how it feels. 

“We’re figuring out ways of examining people without actually touching them.” Said Dr. Smith.

For physiotherapist Chris Napier of Restore Physiotherapy in Vancouver, it was difficult for both sides — patients and physios — in the beginning. 

“Until they’ve had the experience, they didn’t understand the value of it. But people started to accept it more, as virtual was already a huge part of their lives.”  

Tips for your virtual doctor appointment

· Choose a space that is free of background noise and has enough space to perform certain tests and range of motion movements like squats, lunges, etc.

· Dress appropriately in athletic clothing that doesn’t restrict movement and allows visualization of the affected area.

· Set the camera up properly to allow the physician to see the affected body part.

· Send relevant information in advance to help with your diagnoses and treatment.

Dr. Cameron Borody, a sports chiropractor with the Cleveland Clinic in Toronto, says about the only thing they can’t do virtually versus a physical examination is palpation, where the patient is physically touched. and perhaps conduct some orthopedic testing. 

“A lot of time, we can tell if your injury is caused by your supraspinatus versus your subscapularis by just asking you to do a few things for us – just as we would if you were in our offices.”

Napier says physiotherapists often are thought to provide a lot of hands-on treatment, passive therapies, things like ultrasound, electro stimulation, manual therapy and massage, which are difficult to do virtually. 

But Napier says physiotherapy has changed a lot over the last few years, and virtual makes sense. 

“A lot of our treatment focuses on exercise prescription, education, and ergonomic advice, which I would refer to as high-value care that puts the onus back on the patients to heal themselves, but we will coach them through it. While there is always a place for hands-on treatment, but in most cases, it’s the education component and the exercise prescription that is perfectly suited towards virtual appointments.”

And if you think chiropractic services may not translate well to a virtual world, Borody says although there are a lot of manual elements, those in the profession who emphasize rehab and mobility exercises, etc., indicate their patients are happy they don’t have to travel. 

These patients also indicate how successful they were in managing their condition without the typical hands-on component, and they like the added insurance to stay safe and comfortable in their own homes.

As time passes, virtual reality in healthcare is expanding. Innovations and technology are evolving and hopefully will become available for the masses. 

Napier has even embraced wearable technology to help diagnose the gait of runners.  Wearable sensors are sent to his patients, who then go out for a run, and then they upload the information and get a virtual consult. This effectively replaces the in-office running assessment. 

The virtual experience has allowed healthcare providers to triage their appointments. “If someone wanted to see me in the clinic right away, they might have to wait 2-3 weeks,” points out Napier. “But if someone wants a guide on what they can or can’t do – I can suggest a virtual call, and we could connect the next day. This option is also great for the patient, as they can maintain a consistent relationship with their practitioner of choice.” 

“It’s here to stay in some form,” says Borody.  “It may not be the dominant way you’ll see your physiotherapist or chiropractor, but it will certainly be integrated into our practices.”

What if you’re new to the virtual experience? How should you embrace it?

If you’re comfortable visiting the office, do the initial assessment in person and then consider the follow-up online. It can be difficult developing that same rapport online that you would get in person.  

“After all, you have to have that person trust you when you’re telling them what they should or shouldn’t do,” explains Napier. “That trust is going to affect how closely they will follow your advice.  Then once you have that connection, it’s easy to work virtually afterwards.”

Physicians and specialists of all kids agree that there are definite pros and cons to the virtual appointments. Patients love the flexibility and safe options they provide, but nothing quite compares to an in-person visit.

“I still prefer seeing people in person – that connection, that understanding of a patient’s frustration and anxiety from pain, or the happiness and relief from healing and getting better.” Says Smith. “You still can’t capture those emotions virtually the way you can in person – but I am a strong believer it’s here to stay, and the potential is unlimited.”

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