Telemedicine

Telemedicine is a consultation with a SkyHigh clinician conducted by video call or, where the connection will not hold, by phone. It is not a lesser version of coming in. For a specific set of situations it is genuinely the better option, and for another set it is the wrong one, and we would rather be straightforward with you about which is which.

Lagos makes the case for it obvious. A follow up visit that takes ten minutes of clinical time can cost you three hours of the day once traffic and waiting are counted. If nothing about that visit required you to be physically present, those three hours bought you nothing.

What telemedicine is genuinely good for

The common thread below is that the clinician already has a picture of you, or the question can be answered by talking rather than examining.

• Follow up after a consultation or a procedure, where the question is how you are progressing
• Going through results with the doctor who ordered them, rather than reading a report you cannot interpret
• Repeat prescriptions and medication reviews for a stable long term condition
• Ongoing management of hypertension or diabetes, where you have readings from home to discuss
• A second opinion on a diagnosis or a plan given elsewhere, with your documents shared in advance
• Deciding whether a symptom needs to be seen, and how urgently
• Advice before travel, and questions about vaccination
• Mental wellbeing conversations, where many people find a call easier than a waiting room
• Speaking to us about a relative you are caring for at home

What it cannot do, and when we will tell you to come in

A camera cannot palpate an abdomen, listen to a chest, take a blood pressure, look inside an ear, or take blood. Any of those means a physical visit, and a clinician who pretends otherwise is doing you harm.

We will end a call early and ask you to come in where we judge that examination or testing is needed. That is not the consultation failing, it is the consultation working. Deciding that you need to be seen is itself a clinical judgement, and it is a great deal safer than guessing from a description.

• Chest pain, breathlessness, or any symptom that could be a cardiac event
• Severe or sudden abdominal pain
• A baby under three months with a fever, and unwell children generally
• Bleeding in pregnancy, or reduced fetal movements
• A new lump, or a wound that needs looking at
• Anything requiring blood tests, imaging, a scan or a procedure
• A first presentation of something significant, where an examination sets the baseline

Diagnosis is where remote consultation is weakest

It is worth stating the underlying principle plainly, because it explains every rule above. Telemedicine is a good way to manage a condition that is already understood, and a poor way to work out what is wrong for the first time.

Diagnosis leans on examination far more than most patients realise. A great deal of what a clinician learns in the first two minutes of a consultation comes from looking at you, from how you move, your colour, your breathing, and from touching where it hurts. Removing that removes the evidence.

So if you are unwell and you do not yet know why, book a physical appointment. If you know what you have and you need to manage it, telemedicine will usually serve you better.

How a consultation works

Book through the website or by calling the front desk, in the same way as any appointment, choosing telemedicine as the type of visit. You are given a time slot rather than a queue position.

Send anything relevant in advance: previous results, discharge summaries, a photograph of a rash or a wound, your home blood pressure or glucose readings, and a list of every medication you are taking. A clinician who has read your documents before the call can do considerably more in fifteen minutes than one seeing them for the first time.

The consultation is conducted by a SkyHigh clinician, is recorded in the same medical record as your in person visits, and results in the same things: an explanation, a plan, a prescription where appropriate, and a review point.

Prescriptions, referrals and paperwork

Where a prescription is appropriate it can be issued after the consultation and dispensed at our pharmacy in Magodo, or taken elsewhere if that is more convenient. Certain medications cannot responsibly be prescribed without an examination, and controlled drugs are not prescribed remotely at all.

If you need tests, we will order them and you attend the laboratory at Magodo without needing a further consultation first. Results then come back into the same record, and the follow up discussion can itself be a call.

Referrals, sick notes and medical reports can be issued following a telemedicine consultation in the same way as after a physical one.

Connection, privacy and practicalities

Video is preferred because a clinician can see you, and seeing you matters even when a formal examination is not possible. Where the connection will not sustain video, we switch to audio rather than persisting with a call that keeps dropping.

Take the call somewhere private and reasonably well lit, with the camera showing your face clearly. If the consultation concerns a visible problem, good light on that area helps more than anything else.

Your consultation is confidential and recorded in your medical record on the same basis as any other visit. We do not record video, and we would ask that you do not either without telling the clinician.