Remote examination, year 3 student handbook

· It may be possible to get the patient to take readings from instruments they have at home—for example, temperature, pulse, blood pressure, blood glucose, peak expiratory flow rate, and oxygen saturation.

· If you are using video, you can check whether the patient is using their equipment correctly (they may have bought it only recently), and offer instructions

· Some Fitbit-type instruments and smartphone apps can measure biomarkers such as pulse (and rarely, oxygen saturation), but it is very hard to rely on these to provide reliable and accurate readings.

· If you record a reading made by a patient with any of these devices, you need to judge your level of confidence in the reading and make a note of this.

· ENT examination: Inspection of the neck can be viewed by video with good light or patients can upload/send pictures to the practice if any lumps or abnormality are visible. It is possible to have a view of patient’s tonsils/throat via video too.

· MSK examination: It is possible to inspect and observe functionality including passive and active movements, and strength. Some specific tests can be carried out with clear patient guidance including demonstration by clinician.

· Dermatological examination: Dermatology diagnoses are best made by taking a full history and the patient electronically sending pictures of the affected area, because still pictures give better resolution than video. Patients can also measure and carry out tests during a video consult, eg to determine whether a rash is blanching.

· Cardiovascular examination: Most CV diagnoses are based on the history and subsequent investigations. Remote examination can include pulse both rate and rhythm, and a patient can be asked to tap out their pulse to determine the rhythm. If the patient has a monitor, blood pressure can be provided, and the patient can be instructed on how to check for peripheral oedema.

· Respiratory examination: Remote examination is by general observation, respiratory rate and if available pulse oximetry. This provides a very limited respiratory examination, but this has to be balanced against the risk of a face to face examination of an acute respiratory problem

· Gastrointestinal examination: An acute abdomen would need face to face assessment as signs of peritonitis may not be possible to observe remotely. It is possible to carry out a remote assessment of hydration status, general appearance and some obs. As a screening tool, a family member or carer can be instructed on abdominal palpation solely to elicit any signs of tenderness.

· CNS examination: A simple, basic CNS examination can be done via video, including some cerebellar signs. This could give enough information to understand whether patient can continue to be safely managed remotely, or if a more detailed assessment is required urgently in primary care (or secondary care in an emergency situation).

· PNS examination: Neuropathy/weakness can be determined based on the history. Muscle wasting and fasciculations may be identified through video consultations, and it should be possible to observe active movements and global limb strength (tiptoes, squats, raising from chair, pushing up from chair with arms etc).

From: Londonwide LMC (2020) Remote Examination Guide

https://www.lmc.org.uk/visageimages/Covid-19/Remote%20examination%20guide.pdf