Intended for healthcare professionals

Practice What Your Patient is Thinking

Virtual clinics are reassuring but sometimes daunting

BMJ 2021; 372 doi: https://doi.org/10.1136/bmj.n622 (Published 25 March 2021) Cite this as: BMJ 2021;372:n622

Read our latest coverage of the coronavirus outbreak

Linked Practice

Remote management of covid-19 using home pulse oximetry and virtual ward support

  1. Natasha Patel
  1. natashampatel95{at}gmail.com

Natasha Patel describes her experience of a virtual clinic as she tried to manage covid-19 at home between hospital stays.

Managing at home

In April 2020 I went to the emergency department with what felt like an asthma attack that was failing to respond to rescue medicines or steroids. Within 48 hours of arriving, I was notified that I had covid-19. The respiratory team explained that they were going to manage me from home using a virtual clinic.

They asked me to record my heart rate, oxygen levels, temperature, and other symptoms three times a day using an app. A health professional from the hospital explained how to record my heart rate and they arranged for a pulse oximeter to be delivered to me. I was told to contact the clinical team promptly if my oxygen levels stayed below 93% when resting. Knowing that I was going to be managing my health at home, mainly alone but under virtual care, was initially comforting. But it could also be scary, especially when my condition deteriorated.

Keeping in touch

When I got home, I set notifications on the app to remind me to upload the data. With the thermometer and pulse oximeter within arm’s reach I found it easy to track all the information needed. The results were regularly reviewed by a clinician, confirmed by ticks appearing on the app when they had seen my results. The app advised me to fill in the set fields before midday to ensure the healthcare team would have time to review my inputs.

For the first few weeks I also had a call with a health professional most days to go through my symptoms and results from the app. They would contact me more quickly if they were alerted by the app. Knowing health professionals were reviewing my results helped to reassure me during the first few weeks. But sometimes it felt exhausting to talk, especially on days when I was struggling. Having the opportunity to speak to someone on video on occasion, rather than just the phone, would have helped as many of the symptoms I was experiencing could have been missed by not seeing me in person.

A helpful bridge

While managing at home I became increasingly unwell. My oxygen saturation levels were consistently low. I was encouraged by a doctor from the virtual clinic to present to the emergency department again. My condition stabilised and I was discharged home to rest. I continued to be reviewed remotely by the virtual hospital. After another couple of days, I was barely able to stand or stop coughing and again returned to hospital. The virtual clinic was a helpful bridge between hospital stays and I was grateful for that continuity of care.

For months I suffered with breathlessness, feeling extremely weak, muscle pains, blinding headaches, brain fog, and nausea. It was daunting to need to self-manage, measure, and record the data for sharing, but it was great to be able to recuperate within the comfort of my own home. And I am very grateful for having the security of knowing my saturations and symptoms were being recorded and monitored in the acute phase, especially when I was feeling very unwell.

What you need to know

  • Remote monitoring and virtual clinics can help patients feel supported and reassured, but being responsible for data collection and sharing can be exhausting and daunting, especially for patients experiencing brain fog

  • When monitoring a patient who is at home, video appointments can provide additional information compared with a phone call

  • Patients need a contact or a way to speak to a health professional about any concerns they may have between phone calls

Education into Practice

  • How can you ensure a patient who is managing their acute condition at home feels supported and reassured?

  • When might you follow up with a patient who has been seen in a covid-19 virtual clinic?

  • What tools could you use to help a patient who is struggling to manage their acute condition at home?

Footnotes

  • Competing interests: none declared.

This article is made freely available for use in accordance with BMJ's website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

https://bmj.com/coronavirus/usage
View Abstract