Getting more out of a video visit

A video visit for an older parent often goes the same way. Ten minutes lost to the camera and the sound, then a rushed conversation, then someone realises afterwards that the one question they meant to ask never came up.

Almost all of that is preventable, and the fixes are unglamorous. Clinicians have published guidance on what makes these visits work, and most of it is about the twenty minutes before the call rather than the call itself.

What to have in the room

A 2020 paper in Frontiers in Medicine sets out how patients should prepare. Two things top the list.

First, "an updated and comprehensive list of active medications". This is the single most valuable object in the room. In person, a clinician can look at the record and see bottles. On video they are relying entirely on what you can tell them.

Second, numbers if you have them: "recent logs of blood pressure readings, blood glucose levels (from glucometer readings), and weight". The authors note that "having a blood pressure cuff, glucometer, or weighing scale may be helpful in order to record rudimentary vital signs".

This is the part families most often skip, and it is what most directly replaces what the clinician cannot do themselves. A week of readings turns a guess into data.

The setup, which matters more than it sounds

The guidance is specific, and each point exists because of a common failure.

• • "Patients should sit in a room with proper lighting, avoiding light sources positioned behind their backs." A window behind the chair turns the person into a silhouette, and skin colour, pallor and swelling become unreadable.
• • The camera should be "placed as close to eye-level as possible". A phone in a lap gives a view of the ceiling and a nostril.
• • Prop the device up. The paper suggests supporting it "on books or other materials around the house in order to keep both hands free", which matters the moment anyone is asked to move or show something.
• • If a specific area needs looking at, wear "loose clothing that can allow that area to be easily visible if needed". Nothing wastes a video visit like a jumper that will not roll up.
• • Be there if you can. The authors recommend having "a family member or friend present during the visit to assist with aspects of the physical exam or with camera positioning".

What a video visit genuinely cannot do

It is worth being straight about the limits, because knowing them tells you when to push for something else.

The verbal part of medicine survives the format almost intact. The history, which is where most diagnosis actually comes from, works about as well as it does in a room. What does not survive is touch. Nobody can palpate an abdomen, feel a pulse, press on a swollen calf or listen to a chest through a screen.

So a video visit is well suited to reviewing medicines, following up a known problem, interpreting results, discussing a plan, deciding whether something needs to be seen. It is poorly suited to a new physical problem where the answer depends on how something feels under a hand.

If the visit reaches a point where the clinician says they cannot tell without examining, that is not a failure of the visit. That is the visit working correctly, and the right next question is what needs to happen and how quickly.

Three things to do before the call

Write the questions down, in order of importance. Video visits end more abruptly than office visits do. Ask the most important thing first rather than saving it.

Agree who is speaking. When an adult child and a parent are both on a call, they often talk over each other or, worse, defer to each other and nobody says the difficult thing. Decide in advance who raises what.

Test the technology the day before, not five minutes before. Ten minutes of setup burned at the start is ten minutes of a short appointment, and it is the reason the last question never gets asked.

And afterwards

Write down what was decided, what changed, and what happens next, before anyone leaves the room. Video visits are unusually easy to misremember, because there is no paperwork in your hand and no walk to the car to discuss it.