This article talks about online options for patients who are in a hurry to get some answers about their knee problem, but who are unable to travel to see a knee surgeon in person.
What is a second opinion?
A patient may have gone through all the issues about their knee problem with a specialist with whom they have registered. However, they may be uncertain or alarmed about what the specialist told them, and may simply want to compare the opinions of other specialists to see if they all align.
This is not a matter of trust; it is a matter of feeling fully informed about the nature of the problem and the possible options. It may also be an exploration of the particular skills of one surgeon compared to another.
Seeking a second medical opinion: composition, reasons and perceived outcomes in Israel. Shmueli L, Davidovitch N, Pliskin JS, Balicer RD, Hekselman I and Greenfield G. Isr J Health Policy Res. 2017; 6: 67.
Consultation or opinion?
A consultation is generally more expensive than an opinion. The patient may have had an injury to the knee, and feel that things are not right any more. They may be uncertain of what could be damaged and if anything can be done about it. During the consultation, the clinician may have taken details of the story, examined the knee and then looked at the results of any special investigations, such as X-rays and MRI scans. A diagnosis may be suggested, as well as a course of management.
This process may have gone well, yet the patient may have some particular question that is really nagging, such as - "Am I really going to be off competitive sports for a whole year?" They might want an opinion from a specialist who is particularly focused on their particular sport, and in contact with specialised rehabilitation teams, but who may be too far away for the initial consultation.
Sometimes in a consultation, the explanations all go too fast for a patient, and they may want written clarification of a particular issue, so that they can discuss this with their employer or family. They may be more comfortable approaching a clinician who regularly offers opinions, rather than appearing to be nagging their own consultant.
How do orthopaedic surgeons inform their patients before knee arthroplasty surgery? A cross-sectional study. Mahdi A, Nyman MH and Wretenberg P. BMC Musculoskelet Disord. 2018; 19: 414.
How can one have an online knee consultation?
Doctors are generally taught at medical school that they should be able to get close to a definitive diagnosis of a patient just from the patient's story, as long as their questions are pertinent and skillful.
With an online consultation, the patient may have the opportunity to type up the story and correct the dates and circumstances so that the clinician is able to clearly follow what has happened with the knee prior to 'meeting' with the patient via a video link. The specialist may also employ widely-used questionnaires - such KOOS and IKDC - to be able to score and record your symptoms. Images may be uploaded, or hospitals may offer a link to their online copy of MRI scans. You can see a full KOOS questionnaire here.
Yes, there is no 'hands-on' examination, but the combination of the story, carefully-focused questions and the availability of images may go a long way towards the diagnosis and plan of action.
What's it like talking to a knee surgeon online?
Online encounters may take different forms, depending on the systems available to either party. Think of it as 'virtual' meetings. The 'online' part may be the filling in of questionnaires and the uploading of imaging, while the consultation itself may take part over the telephone, or using a telephone-based video system such as 'Facetime'.
If both parties have access to computers and to a decent internet bandwidth, then video consultations are possible. These may be proprietary systems or widely available applications such as Zoom, Google Hangouts, Jitsi and many others. Often it will involve a little bit of trial and error, and the patient may find that they have to agree to the download on their computer of a 'plugin' or small bit of code that helps with the 'video-handshake'.
Does geography matter with an online knee opinion?
If there is no need to actually visit with the specialist, geography should not matter a great deal if the online systems are adequate at both ends. There may be a little bit of regional difference in how a surgeon might manage a particular problem, but that can usually be explained at the time.
