Top tips for remote consultations with people from underserved groups

While online appointments can be beneficial, optimisation of remote kidney care services is required to ensure patients from different underserved groups can have the same experience and outcome as those who do not have specific needs.

Despite the widespread delivery of remote care, digital inequalities and exclusion can be a barrier.

As a practitioner you are likely seeing people with a range of different and complex needs. There may be different considerations unique to that individual that you need to consider when conducting online consultations.

In this section, we outline some tips and links for to further information and resources when having appointments with people who have specific needs.

Learning disabilities

The role of the carer may be very important here (family members or carers may find our guidance about getting the most out of online appointments useful).

Patient choice in consultation type

Engage in a conversation with the patient and their carer to understand their preferences and what works best for them. Remember, they are the experts when it comes to their condition and unique needs. Consider their comfort level and consider using video consultations over telephone to facilitate non-verbal communication.

Ensure you have enough time for appointments

Allow ample time for the consultation and avoid overwhelming the patient with excessive information all at once. If feasible, schedule a longer appointment than usual.

Be aware of distractions

Recognise that patients may find it challenging to concentrate during video calls. Be mindful of distractions in their home environment or on their computer screen.

Patients with learning disabilities may rely more on non-verbal communication and cues. See Mencap’s online resources including information about health passports, which people with a learning disability can fill in prior to a consultation to help staff understand their needs.

Visual impairments

Accessible format

If you are sharing information or questionnaires prior to a consultation, try to make them an accessible format. If that is not feasible, take the time to read the material aloud with the patient.

Accessible technology

Assess whether the patient has accessible technology and familiarity with video calling software and accessibility settings. Encourage them to practice using these tools before the consultation. Additionally, suggest using a large screen instead of a smartphone, as it may be easier for partially sighted patients.

Describe the scene

Clearly explain who is present during the consultation and describe the overall situation to keep the patient informed.

Assess visual capabilities

Ask if the patient can read the names of practitioners on the screen during a video consultation. If not, ensure that each practitioner introduces themselves before speaking. This is particularly important in group consultations or when multiple practitioners are involved.

Reduce noise level

Minimise background noise and interruptions during the consultation, such as rustling papers or keyboard tapping, as they can be distracting and hinder communication.

Visually describe

Remember that patients with sight loss may not perceive non-verbal communication, especially on a screen. If you plan to use screen sharing, pay attention to factors like contrast, brightness, font size, and type. Additionally, provide detailed descriptions of the shared content.

Patient choice in consultation type

Engage in a conversation with the patient to understand their preferences and what works best for them. Remember, they are the experts when it comes to their condition and unique needs.

Further guidance on accessibility for people with visual impairment is available from the Royal National Institute of Blind People.

Hearing impairments

Patient choice in consultation type

Engage in a conversation with the patient to understand their preferred method of communication and what works best for them. Remember, they are the experts when it comes to their condition and unique needs.

Lip reading and video calls

If patients have hearing difficulties but can lip-read, video consultations may be more suitable than telephone calls. However, ensure a good internet connection, well-lit room, and proximity to the camera to aid lip-reading.

Chat function

Encourage patients to utilise the chat function during video consultations.

Family/carer support

Whenever possible, involve family members or carers in the consultation process.

Reduce noise level

When you are not speaking, mute your microphone to minimise background noise.

Consultation technology

Assess if the patient has assistive devices or accessible technology (like the Relay UK app) and ensure their comfort in using them before the consultation.

Closed captions

Some platforms (such as Microsoft Teams and Skype) offer audio captions (subtitles), which can be beneficial but should be used with caution.

Written communication

Whenever feasible, use email and written resources to enhance communication.

For further guidance about video conferencing accessibility see the Royal National Institute for Deaf People or the Royal College of General Practitioners’ deafness and hearing loss toolkit.

People whose first language is not English

Interpreter services

Whenever available, utilise the services of a professional interpreter. If the need arises to use a family member as an interpreter, it is recommended to avoid involving children in this role.

Visual aids

Incorporate visual aids such as pictures, diagrams, and demonstrations of self-management practices to enhance understanding.

Extend appointment length

Take into consideration the potential for extended appointment durations when conducting assessments with an interpreter.

Care home residents

Care home buy in

Obtain the support and cooperation of the clinicians and care home staff involved.

Digital champions

Identify individuals within the care home who can serve as digital champions. These champions can assist with setting up consultations, troubleshooting technical issues, and providing training to other staff members.

Patient history

Recognise that care homes may not possess detailed knowledge of the patient's medical history. If you are unfamiliar with the patient, ensure you do thorough research and gather necessary information beforehand.

Privacy and confidentiality

Prioritise privacy and data protection. Conduct the consultation in a private room away from other residents to maintain confidentiality.

Remote consultations: qualitative feedback from patients

And there was one surgeon, who, while I can read his mouth, it’s very useful and I can have a conversation with him. But, on the phone, not a chance. And I literally spent the whole call just going, ‘Um hum. Yes. Uh huh.'
I struggle to hear them; they also struggle to listen. I’ll say something, and I’m sure they’ve heard but they’ve not listened. I’m not sure if it's an age thing.
I just didn't have the honesty to say, ‘I haven’t understood a word. Can you repeat that, or can you say it more slowly?’ I just pretended I could hear everything.
… it should be on his record that he doesn’t speak English and there should be a translator available.