Medical aesthetic practitioners have had to learn how to develop rapport and read the body language of patients through a screen
In March 2020, like many, medical aesthetic practitioners were forced to think, work and consult differently. As a sliver of light at the end of the long COVID-19 tunnel begins to be seen, it is time to review, evaluate, take stock and figure out how and if we should pivot back. There are many instances when treating patients needs to be a hands-on experience; however, whenever possible, from March 2020 onwards, these in-clinic appointments were reserved for when actual patient contact was needed (or required by law). The rest of the time, medical aesthetic practitioners got a little more creative.
Developments in virtual consultations
The virtual consultation/telemedicine is not a new concept: it was first used in the late 1960s as a tool of necessity for the National Aeronautics and Space Administration (NASA). If people are going to be sent to the moon, they need to be kept safe while travelling approximately 20 000 mph to get there. Yet, over 50 years later, many were still unprepared when the COVID-19 pandemic hit. For years, although there had been a desire (within and beyond the NHS) to move to a more remote model for consultations, there always seemed to be more reasons why they should not be conducted than why they should be. There was always some barrier that could not be overcome, or another reason to delay. By preventing (in some cases) patients from being seen face-to-face, COVID-19 brought an end to these excuses, as medical professionals pivoted and embraced technology to do what they could with what they had.
Unlike the challenges that NASA faced decades ago, medical aesthetic professionals were lucky, as the technology was (largely) already there. After all, the telephone has been around for quite some time now and, at the most basic level of reaching patients, that is all that is needed. However, there is nothing quite like being able to see your patient (particularly in the aesthetics sector, it is essential), so many moved onto a variety of video platforms. The security of the platform of choice was of vital importance and something that users of Zoom will have been particularly conscious of following a data breach on their platform early on during the first lockdown. As ever, patient confidentiality is key—those rules have not changed.
Consultations at a distance
Beyond overcoming the issues around technology (which, for some patients without much ‘tech’ insight, were challenging enough), there were other difficulties to overcome with these new consultation styles. For example, how to develop rapport through a screen, how to read body language and how a patient's full attention can be maintained when they are no longer in your clinic, but in their living room, possibly with all manners of other distractions. Rules of engagement also had to change, as, traditionally, patients automatically know that, when they are in clinic, they need to give the consultation their full attention. Additionally, the medical practitioner must be able to see and have an in-depth discussion on the patient's medical history, so, instead, many found themselves having to set out these same principals in a booking email, alongside details of how to access their virtual consultation. It seems that environment changes everything.
There were so many new challenges to overcome, including how the dynamic changes when one cannot physically meet with their patient. Does the barrier of a screen (or two) interfere with the ability to build relationships? Certainly, when the whole patient cannot be seen, doing a full assessment becomes more challenging. Medical aesthetic practitioners rely on the patient to fully understand the questions being asked and to provide honest answers, which may not always be achievable. A few years ago, I remember one patient who I consulted with (face-to-face), who was in her 70s, and when asked about her medical history, she assured me that there was nothing of note. However, she was wearing a skirt that clearly revealed the scars from two total knee replacements. So, I probed deeper, and it emerged that the total knee replacements were carried out due to her osteoarthritis, and her knees still gave her trouble sometimes. She relayed that, during the night, she often managed to get to the bathroom, but her knees were causing her problems and she couldn't get back to bed. Therefore, she would lay on the tiled bathroom floor for the rest of the night, but she expressed that she didn't mind this, because the floor was cool and soothed the burning pain from the fibromyalgia that she suffered from. This all came from a patient who insisted that she had no medical history of note, and had this been a virtual appointment, I would never have noticed the scars and would have missed out on a wealth of information.
» The shift towards patients taking more responsibility for their own health has facilitated the shift to more holistic skin management, including being able to give ‘lifestyle prescriptions’, for example, nutritional and other health advice that supports aesthetic treatments and maximises their longevity «
Patient studies
A study by Akintomide and Peters (2020) at London's Great Ormand Street Hospital found that, in comparison to face-to-face appointments, virtual appointments yielded a much higher rate of face-to-face appointments as a follow-up from the remote call than was seen where a face-to-face meeting was the only appointment. They concluded that, overall, the results suggested that clinicians are able to virtually deliver care in a meaningful manner, but follow-up appointments were required for in-hospital tests (bloods and X-rays, etc), which would have been completed at the initial appointment usually conducted within the clinical environment. Equally, a patient satisfaction study by Loree et al (2021) demonstrated that 78% of their (oncology) respondents had a positive experience with their virtual appointment, although 72% ranked meeting in person more desirable than a remote appointment. So, this raises the question of what this means for the aesthetics and wellness sector. Published studies for this area of medicine are scarce, therefore, to provide some answers to this question, we surveyed patients from a small, Yorkshire-based practice.
The results were quite interesting. All respondents (n=166) felt that the virtual consultation process was easy, and the technology required was not a problem for them. They all reported feeling satisfied with their consultations and felt listened to (either ‘very well’ or ‘extremely well’). They all felt that they could easily build a rapport across the video consultation platform and, in some instances, rated their virtual appointment more satisfactory than their previous face-to-face one consultation. However, no participants chose to comment if this was due to convenience (for example, no travelling) or the content of the consultation itself.
Despite the virtual consultation being rated ‘very satisfactory or extremely satisfactory’ across the board, if given the choice between the two forms of consulting, over one-third of patients stated that their preference would be face-to-face. While this sample was very small and therefore cannot be considered to be representative beyond the remit of the single practice, it makes for interesting and possibly surprising reading. The survey also examined patient priorities within the consultation setting and found that their priorities very much focused on: ‘feeling listened to and understood’; ‘to understand what treatments are right for me’; and ‘to learn about the benefits and risks of any treatment that I may have’. Although these are very laudable and understandable wishes, no respondent picked the option ‘to build a rapport and get to know my treating medical professional’. This may be because the patient feels that they have already carried out their research regarding the practice and practitioner prior to booking, and, therefore, the triad of ‘like, know and trust’ has already been established. However, it is concerning that there was also a nil patient response to the category ‘to pass across essential medical information’. This may indicate the amount of work still to be done within the remit of patient education and understanding the serious clinical risks that these medical interventions can entail.
Other studies by Lun et al (2020) and Bayram et al (2020) both highlighted positive patient responses to the introduction of virtual clinics and the benefits of building this model into their long-term healthcare vision. They demonstrated the benefits to patients and staff in terms of reduced time, reduced travelling, not waiting for lengthy amounts of time in a crowded waiting room and, for some patients, being able to attend their appointments when they would otherwise not have been well enough to show up.
For those in the wellness sector, where treatments plans can be routinely administered remotely, the COVID-19 crisis pushed medical practitioners into a virtual model, which may have allowed growth well beyond the local areas of clinicians. This can only be sustained using the virtual technologies that many have become accustomed to. In this case, e-clinics are here to stay and grow. Wellness services that are operating within a multidisciplinary team (MDT) may well find a virtual model easier to work within and, in some cases, can allow clinics to function without physical premises. In their study, Wallace et al (2002) found, within their MDT model, a virtual clinic had the benefits of ‘reduced costs, improved reliability, ease of use and quality of transmission’, which they anticipated improving and building on over time. Taking place, nearly 20 years ago, this from a pre-COVID-19 study.
Summary
So, what about the future of aesthetic and wellness clinics, as we drift towards our ‘new normal’? This small survey indicates that, largely, patients still appreciate the environment and feel of a face-to-face consultation. However, with the additional time that this takes (for example, cleaning the clinic between each patient), at least in the immediate future, this may be better reserved for treatment appointments and those who would not otherwise attend a virtual appointment only.
I suspect that the future of digital technology within the aesthetics sector will just become more magnified. With the exception of consultations for the prescription of botulinum toxin, all consultations can be undertaken remotely. The law is clear that consultations for the purposes of prescribing botulinum toxin should be face-to-face, rather than virtual. This may be reviewed in light of the COVID-19 pandemic and in the interests of reducing infection risks; however, there is no legal change at the time of writing this article. That being said, discussions around treatment options, benefits and risks for any treatment can be undertaken virtually in the first instance, even if a face-to-face appointment is required prior to a botulinum toxin treatment prescription (except clinics that can legally hold stock).
Technology has moved on considerably in recent times, and many people are much more self-aware in regard to their own health. This has resulted in more people monitoring their blood pressure, temperature, pulse and oxygen saturation at home, which makes undertaking baseline observations remotely much more achievable. Equally, the shift towards patients taking more responsibility for their own health has facilitated the shift to more holistic skin management, including being able to give ‘lifestyle prescriptions’, for example, nutritional and other health advice that supports aesthetic treatments and maximises their longevity. All these services can be delivered by an online model of care, which is likely to continue to grow and develop moving forwards.
While the COVID-19 pandemic has been tragic and heartbreaking, there is no denying the wealth of opportunities that have arisen. The possibilities for the future are exciting, and having been fuelled by necessity, the barriers that could have prevented advances for many years have been eliminated. Medical practitioners have had to get creative and have stepped up to support their patients. The possibilities are now wide open—let us see how much more we can do!