Seeking appropriate medical care during the lockdown is challenging. It can be hard to understand if, when and where your patient can access care. This is particularly true for acute musculoskeletal problems. Simple tasks like arranging pain-relief, x-rays or braces have become very challenging in the current climate. In most cases patients do not want to go to the emergency department (where there may be exposed to people with respiratory illness) and many services, including some radiology practices and elective surgery, are not available.
It is important that patients who have a need for a clinical acute assessment and treatment are still able to get this safely during the lockdown period. At Axis, we are running a range of acute clinics via telehealth. Our team have protected appointments each day to make sure that these acute problems can still be seen and assessed. Through our online medical platform, we can effectively assess and triage most problems and determine the best treatment approach. We had good feedback from our patients during and after ‘Lockdown 1.0’ early last year. We have continued to use this system throughout 2020/21 because many of our patients preferred this type of appointment.
Patients who have acute musculoskeletal problems are still able to access some face-to-face assessments, investigations and treatments. A good example of this process working well involved a client seen by our team saw last week. She was initially seen by telehealth after sustaining a knee injury. We were able to triage her problem online and arrange x-rays, appropriate pain relief and a knee brace. Unfortunately, the x-rays showed that she had a displaced avulsion fracture of the tibial spine and anterior cruciate ligament. We were able to discuss this with her, again via telehealth, and arrange for her to have an MRI scan. The MRI scan showed an injury that required surgical treatment, and we were able to liaise with the orthopaedic service at the local DHB to have this done in public hospital. In this case, a delay in treatment would have likely led to significant and ongoing morbidity. If you see patients where you think they might require an acute assessment, for example those with a suspect Achilles tendon rupture, severe radicular pain or a painful swollen knee ,it is important that these patients are still seen and assessed. Our telehealth service might be a good option for them.
It would not be appropriate to see non-acute problems in our face-to-clinics or to refer them for imaging. It is important to highlight to patients however that there may be a prolonged wait for a specialist opinion given the uncertainty about the duration of the current lockdown and the likely backlog of patient referrals. As a result these patient may well want to also have a telehealth appointment. This will allow us to make an assessment plan, initiate appropriate treatment and schedule appropriate follow-up or investigations for after the lockdown. We have created a priority list for patient that might need further treatment (for example steroid injections, PRP injections or shockwave therapy) and imaging to ensure that these can be done as soon as practically possible.
We hope that you are all safe and healthy and that your telehealth practice is thriving. Remember that our team is available to give advice and to provide an opinion throughout the lockdown period.