Virtual Consultation

A virtual consultation may suit you if you:

• Would find travelling to a clinic difficult because of pain, distance, work or other commitments
• Live a long way away, or overseas, and want expert input before deciding whether to travel
• Already have recent scans that can be reviewed and discussed remotely
• Want an initial assessment or a discussion of your options without a journey
• Are attending a follow-up appointment to review progress or results
• Would like a preliminary conversation before deciding whether an in-person appointment is needed

It is worth knowing that some problems are better assessed face to face, and if a hands-on examination is important for your particular situation, that will be recommended.

A little preparation makes a virtual consultation run smoothly, and anything missing can usually be sorted afterwards. Where possible, please:

• Arrange for your MRI, CT or X-ray images (not just the reports) to be sent in advance, so they can be reviewed with you
• Have your referral letter and any previous clinic letters to hand
• Provide operation notes from any previous spinal surgery
• Have a current list of your medications ready
• Write down the questions you most want answered
• Find a quiet, private space with a reliable internet or phone connection, and, for video, a device with a working camera

Having your scans available beforehand is particularly valuable, because reviewing the images together is one of the most useful parts of the appointment.

Listening to your story

The consultation begins the same way any good assessment does — by listening. You will be asked about the onset and pattern of your symptoms, any neurological features such as numbness, tingling or weakness, the treatments you have tried, and the impact on your work, hobbies, sleep and quality of life, along with your personal goals. A video or telephone line does not change how carefully this is done.

Reviewing your imaging

Your scans are reviewed with you and explained in plain English — on video, the images can often be shared on screen so you can see what is being described. As always, imaging is interpreted alongside your symptoms rather than in isolation, because scans of pain-free spines commonly show age-related changes that may have nothing to do with your problem.

Guided self-examination

Although a virtual consultation cannot include a hands-on examination, a surprising amount can still be assessed. You may be guided through simple movements and tests on camera — how you stand and move, your posture, certain movements of the neck or back, and simple checks of limb function — which, combined with your history and imaging, often gives a clear picture. Where a formal hands-on examination is genuinely needed to reach or confirm a diagnosis, an in-person appointment will be arranged; this is a normal step, not a failure of the virtual visit.

Reaching a diagnosis and discussing options

Bringing together your story, your imaging and what can be assessed remotely, the aim is to clarify what is causing your symptoms and what is unlikely to be, and whether further investigations are needed. Any recommendations are individualised, and may include observation, physiotherapy, lifestyle measures, medication, spinal injections, further investigations, or surgery where appropriate. Surgery is only recommended when the expected benefits are considered to outweigh the potential risks and when it is appropriate for the individual patient.

It may reassure you to know that remote consultations are well supported by research. In orthopaedic and spinal settings, studies — including randomised trials — have found that video and telephone consultations can achieve care quality and patient satisfaction comparable to in-person visits for appropriately selected patients, with no greater rate of problems related to the mode of consultation. Patients often value the convenience, the reduced travel and the ability to be seen sooner. The evidence also makes clear that virtual consultations are best used selectively — they suit many situations, while some problems still warrant a face-to-face examination. Used in the right circumstances, a virtual consultation is a safe and effective way to be assessed.

Decisions are made together, and never rushed. You are encouraged to ask as many questions as you wish, and you are not expected to decide anything on the day. Being at home can actually make it easier to have a family member with you and to take notes. If you would like another opinion, or an in-person appointment before deciding, that is entirely reasonable.

You will not be left unsure of the next step. Afterwards you may receive a clinic letter summarising the discussion, requests for further investigations, a referral for physiotherapy or pain management, a follow-up appointment (virtual or in person), written information about a procedure where appropriate, or a plan for ongoing monitoring. Not every patient needs surgery, and many need none of the more involved options.

If, after full discussion, an operation is considered, an in-person assessment is normally part of the pathway before proceeding. The route is stepwise: consultation, further discussion, pre-operative assessment, operation, recovery and follow-up. Recovery varies considerably between individuals and depends on the diagnosis, the procedure, your overall health, your occupation and its demands, your age, any previous surgery, and your individual healing — so any timescales are approximate only. You would always be fully informed of the risks, benefits and alternatives first.

Many spinal conditions improve without surgery, and a virtual consultation can just as easily conclude that an operation is not needed. In that case the plan focuses on rehabilitation, physiotherapy, injections where helpful, sensible observation, pain management, exercise and any further investigations. You should still leave with a clear, active management plan.

You are encouraged to ask as many questions as you wish, and writing them down beforehand is especially helpful on a video or phone call, where it is easy to lose your train of thought. Understanding your condition is an important part of treatment.

Care continues after the consultation, and follow-up can often be virtual too. It may include review appointments, imaging review, monitoring your progress, adjusting your plan, and discussing any new symptoms. Distance need not interrupt continuity of care.

The aim of every consultation, virtual or in person, is to provide clarity rather than pressure. You should leave with a better understanding of your diagnosis, the possible causes of your symptoms, the treatment options available, and the next steps. Treatment recommendations are individualised, and the risks, benefits and expected recovery vary between patients. All treatment decisions should be made following consultation with your treating spinal surgeon.

• —Buvik A et al. Quality of care for remote orthopaedic consultations using telemedicine: a randomised controlled trial. (PubMed 27608768)
• —Evaluation of virtual telephone consultations against face-to-face consultations in spine surgery. (PMC11474130)
• —Telemedicine satisfaction and preferences in an orthopaedic spine clinic. (PubMed 36426904)
• —Feasibility, patient/provider satisfaction and value of virtual spine consultation during COVID-19. (PubMed 34389525)