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Supporting patients when we can't be face-to-face

Dr Lindsey Cherry is a Podiatrist working in a split role between Solent NHS Trust and the University of Southampton, Lindsey’s specialism and research interests are in rheumatology and immunological conditions.

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What our "normal" consultation looked like...

If you ask any clinician, I’m sure they’ll agree, there’s a lot going on inside our heads during a consultation. Hopefully, if we’re good at it, for patients it will just seem like a pleasant conversation, maybe about some pretty serious stuff, but always delivered in a calm way that guides someone to make a decision or understand their health and treatment.

Inside my head though, I’m busily recognising patterns, piecing together complex information that’s taken years to master, weighing up whether more information or tests are needed, working out risks versus benefits, and then picking up on subtle cues from my patient, about how best to relay all of that thinking – if at all.

I find I’m responding of course to what people are saying, but perhaps at times even more so, to their body language; gestures that tell me far more than words can about how someone is experiencing their pain, or perhaps how they are being supported by a loved one or friend.

What our current consultations look like...

In these unprecedented times, I’m forced to work remotely, from behind a computer and over the phone. We’ve lost that ability to connect in the ways we used to. I’ve noticed that there is something very different about telephone consultation.

Firstly, its’ just harder. I can’t see you. I can’t pick up on how you managed to walk (or not) into my clinic, I can’t see if you are paler/thinner/frailer than when I saw you last, and I can’t see you when you try to explain where and how much something hurts. But, the silences are more poignant. I can hear you clearly explain to me your assessment of your health and risk. It’s often clear, that with the dices loaded not in favour of a good outcome, that you are really taking stock.

So when you talk to me, the health professional on the end of the phone, seemingly regardless of what my actual role is, for a consultation that you have been waiting days for, with little else to occupy your thoughts, you are prepared and ready with a stream of intense questions. You want me to tell your risk of do this versus do that; but I, just like you, don’t have all the answers.

I’ve noticed that people’s tone of voice and expression of emotion is far less inhibited. At the moment, I’m hearing pent-up frustration, fear, anxiety, sometimes confusion mixed with anger. I’ve had more than one person shout at me down the phone. I can’t completely understand, I don’t have that condition and I’m not in that person’s situation, but I really do empathise. The constant worry we all have is draining for all of us.

I wonder how the tone of consultations will change. In just a few short weeks, I’m noticing polarising groups; those with increasing concern and those who remain stoical. Sometimes, it’s hard to tell over the phone how things really are and what you might really need from me.


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