News: The role of teleconsultation in sports medicine

By Kaylyn Lim, Writer, Communications and Outreach

We have all experienced it firsthand – the pandemic turning our world 180 degrees. Among the many changes, we've had to make, the most notable trend is undoubtedly the shift to digital.

For the general doctor, the same trend is emerging. Teleconsultation, where hospitals or clinics offer patients the choice to "visit" a doctor using video-conferencing platforms, is getting increasingly popular among Singaporeans.

There have been patients who sought advice via teleconsult over Covid-19 symptoms and were found to have the virus after testing at a hospital. With this method replacing traditional consultations, patients can seek professional advice from home while keeping themselves and others safe.

However, what about orthopedic or sports injuries? With the lack of physical contact and examinations, how do doctors then identify such injuries, and give proper advice on treatment?

The LKCMedicine approached two students from the second intake of Graduate Diploma in Sports Medicine (GDSM), Dr Chia Mei Fen and Dr Rachel Chan Sheau Hue, both of whom frequently practice teleconsultation. We asked them about the ins and outs of teleconsultation, and their personal take as a practitioner. 

Dr Chia Mei Fen, GP at Healthway Medical

I started teleconsultation in mid-2020 as an adjunct form of consultation, due to the pandemic situation. Our company, Healthway Medical, had already planned to widen the scope of medical services through developing an online platform. Currently, we host teleconsultation sessions through an app.

I have been seeing an increased trend in patients who opt for teleconsultations. I usually see up to 10 patients via teleconsultation, with each session lasting 10-20 minutes.

Teleconsultation has helped us to reduce exposure and contact between patients and doctors. I usually undergo thorough history taking since we are unable to perform any physical examinations. To better understand their situation, we will also explore the patient's exercise regime, hobbies, exercise goals, as well as social and occupational hazards.

A difficulty I face is that we are unable to perform any physical examinations or special orthopedic tests, crucial for the diagnosis of orthopedic and sports conditions. However, there are areas in which I prefer teleconsultation over physical consultations, such as convenience for my patients. Additionally, patients who are usually keener on teleconsulting are those who have prior knowledge or have been educated on their condition.

GDSM has played a part in helping me better diagnose patients through teleconsultations. It helps me to better understand management, risk factors, preventions, and more. The knowledge I have gained also allows me to reduce unnecessary referrals.

I feel that while teleconsultations will not be able to replace conventional consults, it will be more utilised and generally welcomed by hospitals and clinics in the future.

Dr Rachel Chan Sheau Hue, Deputy Physician Manager at WhiteCoat Medical

In October 2018, I started holding teleconsultation sessions. The company I joined, WhiteCoat Medical, is a digital healthcare provider that offers telemedicine services. I do on-demand teleconsultation via real-time video communication.

I usually hold teleconsultations five days a week, with musculoskeletal consults usually lasting between 10 and 15 minutes. Since I have started, there has been an uptrend in the number of patients using telemedicine. I believe that the Covid-19 pandemic has accelerated the adoption of telehealth in the region, as patients try to reduce the risks of visiting a physical clinic.

The general steps of a teleconsultation are similar to that of a normal consultation. Tele-consultation usually comprises the following components:

i. History of presenting complaint

ii. Examination

iii. Diagnosis

iv. Medical Advice and management

Currently, the main limitation of telemedicine is the inability to do physical examinations. This is partially mitigated by guided self-examination in a cooperative patient. I also prefer the aspect of patient convenience. Sports injuries may have affected the mobility of patients who are likely to seek professional advice via teleconsult, thus teleconsultations will be easier for them.

A large part of patient assessment is in detecting red flags of a condition, and the LKCMedicine GDSM course has equipped me with the skills and knowledge to do so.

The GDSM course has also equipped me with skills and know-how of exercise prescription and nutrition, which has been helpful for patients who wished to lose weight via lifestyle management, and for patients with chronic diseases who wish to start an exercise regime to control these conditions. 

Additionally, I found the clinical attachment to sports clinics during my time at GDSM particularly useful as I got to learn how physical therapy is taught and implemented. This is not an aspect that is commonly covered in other types of training I have undergone, and it has greatly helped me in managing my patients.

Telemedicine will likely grow in popularity in the future due to its convenience, but it cannot replace physical consultations, as not all medical conditions are suitable for telemedicine. But for those with conditions that are suitable for teleconsultation, this convenience is a major plus and will play a part in how we perform consultations in future.