Table 1

Advantages and disadvantages of video consultations based on our experience

Advantages of video consultationsDisadvantages of video consultations
Accessibility—reducing infection risk
  • During the COVID-19 pandemic, video clinics posed no risk of infection to patients or clinicians and allowed shielded patients/families and clinicians to engage in clinics from home safely.

  • This enabled multidisciplinary assessments to be undertaken remotely.

Accessibility—increased convenience
  • Many families stated it was more convenient to be assessed at home, avoiding transport costs, transport time and reducing time off work.

  • Video clinics increased flexibility of clinical time for both clinicians and families and were easier to schedule.

  • Using video clinics helped alleviate the problem of limited clinic room availability, especially considering social distancing guidelines.

Accessibility—technical aspects
  • 45% of consultations in the first 2 months experienced technical difficulties; difficulty following access instructions, internet connection problem, phone batteries dying and problems with camera or sound systems on either side.

  • Internet connectivity may be worse in rural areas, limiting access to video consultations.

Accessibilit—social aspects
  • The most vulnerable families (eg, digital poverty, language barriers and parents with learning difficulties) struggled to access video consultations, making safeguarding concerns more difficult to assess; many families did not have the equipment, ability or data/internet package to access the video platform.

  • This gap in accessibility may exacerbate existing health inequalities in access to services.

  • Video consultations were not acceptable for a minority of families who declined this option.

  • Parental controls; in many cases the child was able to access the video platform, but parents or carers were less ‘tech savvy’ and could not regulate internet safety.

Clinical assessment
  • Parents reported their child behaved more ’normally’ and were more comfortable at home than in the clinic setting.

  • It was helpful to see family living conditions particularly in assessing social determinants of health, such as child poverty.

  • Patients were generally thankful for the offer of virtual consultation and happy with the discussion and plans made.

  • Helpful clinical decisions were made; 70% of children assessed by video consultation were offered a follow-up assessment within the service (face-to-face general developmental or specialist clinic); 30% could be discharged from the service.

Clinical assessment
  • It can be more difficult to establish initial rapport and trust over video compared with face to face. Consultations tend to be more ‘adult centric’ and children are not always as engaged in consultation. Techniques we employ to focus the consultation around the child in a physical environment (body language and positioning) may not be as easily translated on video.

  • Concerns about privacy and confidentiality; we could not be sure who was in the consultation environment, and it was difficult to ensure we could speak to the child or parent alone when appropriate.

  • Many children will still need face-to-face assessment at some stage to complete physical examination or further developmental assessment.

  • Increased clinician fatigue was reported due to the need to interpret subtle non-verbal communication over electronic media.