During the Covid-19 pandemic, most appointments and consultations for kidney patients moved from being carried out in-person to being delivered on the phone, over video calls, or through messaging services.
A 2023 survey suggests up to 50% of appointments are still carried out remotely. This kind of consultation is becoming more common in all areas of life, but for patients and for doctors remote care can still be a new experience, with its own challenges – and benefits.
Remote appointments: the benefits for kidney patients
People appreciate remote appointments because...
- They can help avoid the stress and cost of travelling to hospital.
Sometimes you go all the way there just to have a little chat and you think ten, fifteen minutes and you’re out, and you could have done that on the phone without the travelling, the stress of the travelling and finding a car parking space.
I had a clinic appointment yesterday and it took me over an hour to get to the hospital whereas normally it takes half an hour and with traffic and the car parking and all the anxiety and stress related to that, it caused my blood pressure to increase so when I had my blood pressure taken in the clinic, they were wondering why it was so high.
- There is more flexibility around work and life.
I’d say it’s quite a lot easier to fit it into my life and so it’s like I’m not having to fit into it, it fits into what I want to do and how I’m doing things.
Since lockdown I think I’ve gone in twice to see my consultant but other than that, I do it online and I do it at home and it works out perfect because I am able to chat to him.
- For clinically vulnerable patients, remote appointments can be safer than face-to-face visits.
[During Covid] we were all shielding for months and months and months. I think that was very scary, especially if it is a transplant because you didn’t know if you were safe to go in.
Remote appointments: the challenges for kidney patients
- Sometimes you need to have a physical examination and there can be less of a ‘personal touch’.
For transplant clinics, especially, it’s inappropriate because you can’t look at someone’s ankles and see if they’re swollen; you can’t look at their skin and see if they’re dehydrated.
I miss that sometimes, not seeing them and seeing what’s happening, I miss the personal contact.
- You can feel rushed and find it hard to ask questions.
[The medical team] can be very brisk. And, even though they say, ‘Have you got any questions?’ the way they say it is not actually inviting you to say any of them.
- It can be harder to build a relationship with your doctor or nurse.
You need to get to know your consultant and you won’t get to know them online, it won’t be real.
What can I expect during my remote appointment?
Though not every appointment is the same, much of the time remote appointments will be similar to what you are used to with in-person appointments.
- Greeting - The doctor or nurse will call up and say hello. Don’t be concerned if they do not call at the exact time – they may be running late. It’s worth holding out for 10 to 15 minutes if you are using a video call.
- Introduction - If you are not known to the doctor or nurse, they might ask for your name and date of birth to confirm who you are.
- Review - Next they may review your last appointment, and ask for an update.
- Discuss - your doctor or nurse should ask what you want to talk about. Take a look at the list below to see some of the areas you might want to discuss.
- At the end - you will be asked if you have any other questions or worries. You might feel rushed, but don’t be afraid to say what you need!
- After the call - your next appointment will be scheduled, or you might be asked to get in touch with the admin team at your practice to arrange one yourself. You can usually expect a letter summarising what you talked about at the appointment. Don’t be afraid to ask if you need one!
What can I talk about during my appointment?
- Any signs or symptoms you are worried about
- Recent blood results
- Mobility, daily living, and support needs
- Medicines you are taking
- Your diet
- If you measure them at home, things like your blood pressure, blood sugar, or weight.
- How you are feeling, and your mental health
- Personal updates, like issues with your job, holidays, or family life
How to get the best out of your remote appointment
Whether you’re a long-term patient or new to kidney care, remote appointments can be tricky to manage. To get the most out of your appointment, you can try filling out an appointment checklist to help you prepare.
Consider whether a remote appointment will work for you
If you are a new patient at the renal unit, think about whether a remote appointment is a good fit for you. Don't be afraid to ask your kidney team if you’d like to see them at the hospital instead of having a call at home.
Ask 3 questions
Your healthcare team want to help you become more involved in your care by giving you information about your options. Knowing what’s important to you will help them to help you make the best decision for you.
To help you understand your options and make better decisions about your own healthcare, try asking these three questions.
- What are the benefits? Make sure you understand the benefits to your health if you agree to the procedure/treatments.
- What are the risks? You should be fully informed about the effects of this decision, both short and long term.
- Are there any alternatives? Ensure you are aware of all the options, so you can decide if a different option better suits your healthcare needs. You can also ask:
- What if I do nothing? Remember that just because treatment is available, it doesn't mean it's right for you. Make sure you fully understand the impact on your health if you choose not to have treatment.
Before your appointment: find the right space, get your tech ready and think about what you want to discuss
- Find somewhere quiet and private to talk if you can.
- Try to avoid any interruptions (for example, from children or pets).
- Check that your phone or computer is working before your appointment. You might need to charge your device or move to an area with good signal.
- Consider whether you have a family member, friend or carer who can support you during the appointment (for example in using the technology, holding the camera or taking notes) so that you can concentrate on what is being said.
- If you are hard of hearing, consider using a headset to cut out background noise.
- If you have a telephone appointment, check whether you have any call blockers or guardians on your phone. If the practitioner is calling from their workplace the number may be unknown or unrecognised and they might not be able to get through to you.
- Prepare a list of topics you want to cover – as time may be short, choose three most important things to discuss. The rest can be covered if you have time at the end or in a later appointment.
During your appointment: prepare the information you might need and think about what questions you want answered
- Always have your tablets or a list of your medication ready.
- Prepare a photo or video if asked for by a doctor or nurse – they may ask you to take a photo or record a video before or after the appointment so they can monitor your condition.
- Think carefully about how to describe your condition or symptoms, and be specific about details (for example, the exact location the pain is coming from, what triggers the pain and whether it is constant or intermittent).
- Write down any questions or concerns you may have to help you remember to discuss them. This may include medications, blood results etc.
At the end of your appointment: think ahead
- Check your list to make sure your key questions have been covered.
- Ask the practitioner to summarise what was discussed, or to explain anything that is not clear.
- Make sure you understand what the next steps are.
Getting support for your extra needs
If you or a loved one have extra needs, there are some parts of the remote appointment experience you may need to think about more. Here are some tips to help you ask for the help you need.
I have a learning disability
- Ask for more time if you think you will find a normal-length appointment too difficult.
- Ask your doctor or nurse to speak slowly and clearly.
I have mental health needs
- Don't be afraid to ask for help with your mental health.
- Ask about what support if available for people with mental health issues.
I have problems with my eyes or hearing
- Explain how much you can see or hear.
- Let your kidney team know if there is specific technology you would like them to use.
- Practise using your special technology before the appointment.
- You could also try using a large screen instead of a smartphone, as it may be easier if your eyesight is not so good.
- If you can't see well, a telephone appointment might be better for you than a video call.
- If you have hearing difficulties but can lip-read, video consultations may be more suitable than telephone calls. However, ensure you have a good internet connection, a well-lit room, and you are close to the camera for easy lip-reading. You can also use the chat function. Finally, some platforms like Skype offer audio captions (subtitles).
- Reduce background noise and interruptions during the appointment, such as TV audios or other people in the background, as this can be distracting.
I can't speak or understand English very well
- Ask your kidney team if there is an interpreter they can use.
- You can ask a family member or friend to translate for you, but you might prefer to have someone from the hospital. Try not to ask young children to interpret for you.
- Ask if there are photos, pictures, diagrams or videos that can help you.