Video Consultations: a 10 point guide


1. Why a video consultation?

  • In light of the COVID-19 pandemic, doctors and other health care professionals are using technology more to reach their patients. 
  • With video consultations you can receive specialist medical advice at home while reducing the risk of COVID-19.
  • The main drawback is the lack of a formal examination which limits how much progress can be made.
  • Assessing ‘New’ patients is more of a challenge than ‘Follow ups’.

Video consultation with Rheumatologist

2. Is video consultation right for you?

  • Do you need a video consultation? Would a simple phone call do? 
  • Is the doctor known to you? In any case do your research. Look at their professional website. Check review sites like ‘Doctify”.
  • Will it be a First /New patient consult or a ‘Follow up’? If ‘New’ contact the professional first.  Not all problems can be assessed in a video call.
  • Is this an NHS service or private? If private check costs and that your insurance will cover it.

online Rheumatology consult

3. Choose your location

  • You need a stable internet connection for clear image and sound.
  • Choose a quiet, well lit area where you won’t be interrupted or distracted.
  • Sit in a comfortable seat, positioned upright and forwards so your doctor can see you clearly, not hunched over your screen.
  • Do you want someone sitting in with you? If so, is there room for them? It helps the doctor if they can be seen too. Their reactions and comments give useful cues.

Rheumatologist on line

 4. Choose your device

  • A laptop or desk top computer is usually best, allowing you to sit facing the screen and to be hands-free. It will be easier to talk to you if not too close or looming over your screen.
  • Mobile phones are not ideal.
  • iPads work well if propped up vertically.
  • Whatever you use have the charger plugged in and check it’s working.

Rheumatology video consultation Cambridge

 5. Which app or software to use?

  • Check with your doctor; the choice of software may be dictated by their equipment (eg they might not use WhatsApp) but they might be flexible if they know in advance.
  • If you have a Mac device, FaceTime might be best.
  • Other internet based services like ‘Zoom’ can work well.
  • If you are not used to the software arrange a practice call with someone ahead of time to familiarise yourself, and to check it all works.

Rheumatologist video consultation Bedford

6. Prepare what you want to talk about (and for what you might be asked)

  • Think about what you want to talk about. Make a list.
  • Include when your symptoms began and how they developed.
  • Jot down a list of any past medical conditions.
  • Have any medications upset you? Any allergies?
  • Have you had any relevant tests, scans Xrays? Where were they done? Can you get the results?
  • For a follow up consult consider how things have changed – what has improved and what hasn’t?
  • If you are on medication – has it helped or not?
  • Do any relatives have similar problems?

Rheumatologist online

 7. What to have close at hand

  • A back up phone number to call the doctor when the connection fails.
  • Useful identification details – your hospital number or NHS number may help.
  • GP Practice details including their email and phone number.
  • A list of all your medication.
  • Any relevant medical reports you may have, doctor’s reports, test results.
  • Pen and paper.

8. The consultation

  • Settle in 10 minutes early and check everything is working.
  • Check the arrangements – were you to call in or wait to be contacted?
  • When the call starts – check you are speaking to the right person and confirm who you are. Introduce anyone else even if ‘off camera’.
  • Check you and the doctor have good picture and sound.
  • Don’t be put off if the doctor isn’t always looking at you ‘eye to eye’. The camera is off centre and they need to look down to make notes etc
  • Check your list as you go along to make sure everything you want to cover is discussed.

9. Winding up the consultation

  • Ask for a discussion about your questions and then request  a ‘summing up’.
  • Agree the plan, tests, treatments and the next steps including:
    • follow up appointment
    • prescription for medication if needed
    • what to do if things don’t go as planned

Rheumatologist near me

10.  After the consultation

  • You should receive a report such as a copy of the letter to your doctor or at least a summary of the consultation.
  • If anything has been missed out, misunderstood or if you remember something extra do contact the doctor.
  • Let your doctor know how you felt the consultation went and how it could be improved.  
  • Consider giving feedback on a review site to help guide future patients. 

Gout: top 10 tips for patient and doctor

Gout, urate, uric, Rheumatologist, Allopurinol, colchicine, febuxostat

1.  Remember: Gout is common

  • When joints suddenly become swollen and painful, your first thought should be gout.
  • About 2.5% of people in the UK have gout and their number is increasing.
  • Gout is 5 times more common in men than in women and your chances of having it increase with age: at age 65-70, 10% of men and 2% of women have gout.

Urate Uric Gout

2. It’s all about Uric Acid -what’s that?

  • The white chalky substance in bird droppings is uric acid (or “UA”).  You know what it does to your paintwork, imagine what it does to your joints.
  • UA is produced when we breakdown chemicals called purines, which are the building blocks of DNA and found in almost all foods.
  • High levels of UA can lead to the accumulation of crystals in the tissues.  These crystals trigger sudden and often disabling attacks of joint pain.  Over time this damages joints.
  • UA can form stones in the kidneys and build up deposits under the skin called tophi.
  • What causes high UA levels? In the majority of cases it’s because the kidneys are not removing UA efficiently.  This is often hereditary but a high total intake of purines in the diet worsens the problem. Some people “over produce” purines because of other medical conditions and, very rarely, high levels can be due to genetic abnormalities.

Heart Myocardial infarct gout

 3. Take ALL gout seriously

  • It’s not just joints that are at risk. The first attack of gout is a warning of health problems in the future.
  • People with high UA levels have increased risk of heart attack and stroke. This effect is magnified since people with gout tend to be heavier, with higher blood pressure and greater diabetes rates; the (Metabolic Syndrome).
  • So, if you have these problems and now find you suffer from gout too, your health risks are even higher.

Blood uric urate gut rheumatologist

4. You can’t diagnose gout with a blood test, but it does help!

  • When gout starts in the usual way – with sudden pain, swelling and redness in the big toe – it’s fairly easy to diagnose.
  • Some people, however, have attacks in other joints, especially as the gout advances.
  • UA levels go down while you are unwell, so it’s best to check the levels once the acute attack has settled.  It’s useful to have blood tests for Rheumatoid Arthritis (Rheumatoid Factor and Anti-Citrullinated Protein Antibody) at the same time.
  • If the cause of attacks isn’t obvious, look for hard yellow collections of UA crystals under the skin (tophi) which will clinch the diagnosis. 
  • If there is fluid in a joint your doctor can draw some out look for crystals in the laboratory.

prawn seafood gout

5. Concentrate on changing lifestyle, not just eliminating ‘Trigger Foods’ 

  • Most people are aware that certain foods may trigger gout attacks. Seafood, red meat, offal and beer often bring on attacks, but just avoiding “trigger foods” won’t cure the problem.
  • Dieting reduces the UA level by  about 10%  but weight loss must be gradual as crash dieting can bring on attacks.
  • If you are overweight, work hard on weight reduction. We should all focus on “Healthy Eating” but this alone isn’t enough for most. Cut calorie intake and combine with steady weight loss . This can reduce the number of attacks and significantly decrease the health risks that go with it.
  • Don’t forget! Alcohol contains a lot of calories, as do sugary drinks.

6. Control the ‘flares’

  • Acute attacks can be really painful and disruptive so you need to know how to control  them.
  • Anti inflammatories are widely available and are often used as “first line” treatment.  Colchicine  can help shorten attacks but many people get nausea and diarrhoea at higher doses or in combination with some other treatments.
  • Occasionally short courses of steroids for a few days are helpful.  Injection of steroid directly into the joint seems drastic but can be very helpful.
  • Believe it or not eating cherries or taking cherry extract can cut the number of attacks while the crystals are dissolving, but many patients still have attacks. 

Allopurinol gout uric urate

7. Don’t wait too long to start long term medication to sort out gout

  • As more and more crystals accumulate in the joints, skin and kidneys it gets harder to control gout. The more crystals you have built up the slower the recovery.
  • The usual first treatment chosen to lower UA levels is Allopurinol. 
  • Febuxostat can be used if there are problems with Allopurinol.
  • Some Rheumatologists use Febuxostat  first especially if there are problems with the kidney function.  There are other treatments to try if these are not successful.

Uric Urate gout

8. Know your UA levels. Aim for a target of 360μmol/L (6mg/dL)

  • If you have gout it is vital to check the UA level to see if is going down with the changes you make.  It turns out that the magic number is 360.
  • Below a blood level of 360μmol/L the crystals slowly dissolve. Sometimes a lower “target” of 300μmol/L (5mg/dL) is chosen to speed up the clearance of crystals especially if there are large tophi.
  • In the “Treat to target” approach the UA levels are checked every month and the Allopurinol dose is slowly stepped up until the UA is at target. It can take a few months after that for the attacks to settle. 

tops gout complication uric urate

9.  If you start on treatment – stick to it or the gout will return

  • Long term it is a good idea to check the UA levels once per year keep gout under control and avoid complications. 
  • In the UK 40% of patients given long term treatment such as Allopurinol do not stick to their treatment plan. 

lifestyle weight uric rate

10. You’ve made ‘lifestyle changes’ – now stick with them long term

  • Now your gout is under control that doesn’t mean you can forget the lifestyle changes. You still need to stick with these changes to keep it at bay, and to control risks of other problems like heart attack and stroke.