How to handle patient requests for a virtual diagnosis

I was recently asked the following by a Clinician:

Can I ask you to cover in a future bulletin how you handle the people who call up wanting you to virtually diagnose them over the phone, or via email or text message or Instagram or FB messenger?

I do try my best to help these people and encourage them to come and see me, but it can be a wormhole of lost time, if you have any tips, I’m all ears.

How do you handle these kinds of requests in your Practice?


Here’s my take on it.

When patients phone up or connect with us, we should start with the assumption that this is a good thing. After all, it’s a chance to convert them into a patient (who pays us for our time). However, when we communicate with these patients, it’s really important that we bear in mind three things:

Don’t advise when you shouldn’t.

Keep it confidential.

Remember that your time is your money.


Hopefully, it goes without saying that we ensure that whatever we say or do would be in keeping with good clinical care. What I really mean here is, sometimes we feel obliged to try to solve the problem, when we really aren’t in possession of the full facts.

We haven’t met the patient, let alone examined them, and so we need to be very careful about giving advice to patients in this situation. If a patient contacts you about a sore toe, how do you know that their pedal pulses are ok, and that the rough skin they complain about, isn’t in fact the trophic changes in a vasculopathic foot?

The place for discussions is definitely not on social media. The moment you need to engage in any kind of clinical conversation, it needs to happen in a secure (and GDPR compliant) place. That means either via encrypted email, or a phone call (see point 3). WhatsApp and Facebook messenger are a no-no.


This is the area that I think people get most tied in knots over. You may want to engage in a quick conversation with the person connecting with you, because you might be able to help them, and thus ‘land’ them as a patient. Each time you spend time communicating with patients in this way, it’s your (unpaid) time. How many times have you ‘given away the barn’ before?

It’s worth flipping your mindset and putting yourself in your patient’s shoes.

They want to make sure that you can help them and that coming to see you wouldn’t be a complete waste of their time and money.

They may be thinking ‘is my problem really a podiatry/physiotherapy/osteopathy/knee surgical problem? In my own Private Practice, I encounter this kind of situation regularly. I find it really helpful to pre-empt the ‘who’s the right person for me to see’, by actually talking about it.

I might quickly say (or type) the below:


‘some people are wonder if they should come to see an Orthopaedic Surgeon, or a Sports Doctor, and as a rule of thumb, if you’ve had significant trauma to your knee, or you’re struggling to weight-bear, that might be a reason to see a surgical person, but for most knee problems, I’m a great starting point, because thankfully most knee pain situations can successfully be dealt without surgery’.


I’d then suggest making a ‘call to action’ statement.


‘It sounds like you’re struggling with that, and to make a proper assessment and advise you further, it would be great to see you in clinic, so I can examine you and we can get a proper diagnosis and a plan of action in place. Shall I connect you with my secretary, so we can get a clinic appointment set up?’

This a good way to separate out those patients who are committed to investing getting help for their problem, and those who are on the scrounge for a freebie.


Very occasionally, you may have a patient who still pushes for more, and may even go as far as to try to discount you, or ask for a free opinion. Resist being guilt-tripped into this. It’s not your role to solve everyone’s problems, and in my experience, those who ask for a discount typically turn out to be nightmares to deal with.


To best deal with this, prepare in advance. Have a little script that you can rattle off – ‘I don’t give discounts, because that wouldn’t be fair to my other patients, but remember you could approach your GP for an NHS referral’. Or, if the person were pushing to be seen for free, you could say ‘sorry, all of my pro-bono quota for this month has already been allocated’.

Remember to make it super easy for the patient to book in with you. If you have a secretary, link them into the email conversation, or if you self-book, send them to webpage where they can book online, or give them a phone number to ring to book in on.

Finally, you can turn these situations to your advantage. Why not consider setting up an on-line video consultation service? You could offer low-cost, triage appointments, and if the patient ‘converts’ to a clinic attender, you could deduct that from the price of a full consultation?

Need some more help with the above? Email me directly on, and let’s get building your successful, happy Private Practice!

Now it’s time for you to grow your Private Practice.






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