Here is the YPHSIG guide to best practice when undertaking remote consultation with young people.
Is remote consultation appropriate?
Before you begin the call it is important to consider whether a telephone/video or face-face is an appropriate medium for the consultation. A face to face consultation may be required if there are one or more of the following:
- Safeguarding concerns
- Need for examination including examination of medical devices
- Barriers to effective communication
- Need for face-face assessment
- Need for investigations
- Measurements of growth or assessment of puberty are needed
- You need to communicate bad news
For trainees - Does the responsible consultant agree that remote consultation is appropriate?
Can you access the young persons medical record?
Ensure you have access to the young person's medical record and results of investigations.
How will you prescribe any treatments required?
Consider how will you prescribe for this young person: How will they fulfil the prescription? Is the treatment available from a community pharmacy?
Provide the young person with choice
Whenever possible provide options to young person eg F2F, video and telephone so they can make a choice
Pick the right platform
Consider which is the best platform to use. Ideally the platform should have these features:
- free to use for end user
- easy to use
- functionality (able to send documents and forms)
Familiarise yourself with the equipment and test the video and audio prior to the call. Do you know how to mute/unmute and toggle the video on and off? Do you know how to end the call?
Consider if the young person or their parent/carer has any special communication requirements
- Interpreting services
- Hearing and/or visually impaired
Provide the young person with information on
- how they can connect
- what to expect during the call and support their participation
- how the young person and their information will be kept safe during the call
- how to give feedback to complain/provide a compliment
- Don't forget "hello my name is...." and explain your role and the reason for your call
- Check the young person is free and safe to take your call
- Seek verbal consent to proceed
Establish who is on the call/in the room and discuss privacy
Establish who is on the call/in the room both at the patient's end of the call and at your end. Introduce anyone ese on the call to the young person. Names and roles of all the call participants should be documented in the medical record.
Establish the agenda
- What is the purpose of your call today?
- How long do you anticipate the call will last?
- What does the young person wish to achieve by the end of the call?
- What does the parent/carer wish to achieve?
Offer independent consultation
- Using a script can be helpful
- Document when offered and undertaken
- Ask what they already know
- Describe confidentiality and it’s limits
- Check understanding
- Establish who and where written communication should be sent to
- You may need to consider specific arrangements for CLA – social workers/foster carers/parents and managing confidentiality
Use psychosocial screening tools
It is important to remember that psychosocial screening eg HEEADSSSS is still a key component of developmentally appropriate healthcare for young people.
If you need to examine the young person arrange to see them face to face
We caution against examining young people on video call beyond what you would normally be able to see on a video call. Exposing body parts on camera may give mixed messages to young people about this being an acceptable practice. Intimate examinations should never be carried out virtually. This includes examination of genitalia of all children of all ages, and torso/chest of pubertal children. Sharing explicit images of children is a criminal offence.
If examination over remote consultation is the only option available the consider the need for a chaperone. Follow the missive that -if it applies to face –face exam it will also apply to a video exam.
After the call
- Establish the follow up plan –determine if next call needs to be face-face
- Ensure documentation completed
- Ensure summary sent to young person and where appropriate parents/carers,
- Seek feedback – this is new and we are all learning with a particular focus on access and understanding whether access for groups with specific characteristics is equal