Primmer: Connecting with the patient

As we move into a more digitized world, Telemedicine and Telehealth are quickly becoming the main source of interaction with patients. Thanks to rapid changes in our daily customs, culture, and world events, these sort of appointments are now widely available to previously in-person only communities. With this change in healthcare and doctor-patient interaction, it is important that we understand the proper way to conduct the visit in order to minimize miscommunication, ensure patient satisfaction, and gain enough information to form a diagnosis. This article will serve as a guide on how to be successful in your Telemedicine appointments.

Creating an Impression

Appearance: First and foremost is going to be your impression on the patient. Just like an in-person visit, how you present yourself is key. Maintaining professionalism during a video consultation will help show the patient that your virtual interaction is just as in-depth, professional, and important as your in office visits. You will want to wear what you usually do in the office, whether that is a blouse, a shirt and tie, a dress, or more casual attire, you want to look like you. If you wear your white coat in the office, wear it on the call! The key is maintaining normalcy and professionalism. Don’t wear anything you wouldn’t feel comfortable going into work in; you don’t want to look like a slob. Your attire and grooming will be your first impression, so take care in your appearance. Looking clean will subconsciously improve the patient’s impression of you and their visit; you will appear more trustworthy, authoritative, and intelligent.

Your environment: Like  appearance, the space in which you conduct your visit is equally as important. The American Academy of Allergy, Asthma, & Immunology did a study of backgrounds in which it found that doctors with a door behind them gave off a negative impression, subconsciously indicating their desire to leave. While this may not be the intention, it is important to avoid this subconscious assumption and place yourself in a comfortable, well lit space void of any doors or other distractions. Consider a plain wall, a clean living space, or the corner of your office. Regardless of where you choose to do your Telemedicine visits, think about what your visual space may say about you.

The video frame: After you have found your appropriate attire and background, you should take care in setting up your video frame. We all know that little frame where we can see ourselves in the call, so take a second to see what you look like and position yourself clearly in the center so that none of your face is obscured or cut off. Nice framing can make a world of difference and helps the patient see you well. Additionally try to avoid severe angles, such as very low or high positioning of your camera; you want to be able to comfortably look at the camera. A low angle may seem as though you are looking down on the patient and a high angle comes across as impersonal and unnatural, so think about an eye-level, or just below, position. This positioning will make maintaining eye contact much easier.

Eye contact (Can be tricky): Now let’s talk about “eye contact.” While your first instinct may be to look at the patient on the screen, this does not actually come across as eye contact or engagement. Some patents may know that you are looking at them on the screen if they have experience with video calls, but go in with the assumption that this is the individual’s first time. The key to “eye contact” is to look at your camera lens, this ensures that you appear to be looking directly at your patient. Looking at your camera may feel a bit weird at first, but this is the best way to make sure you convey sincerity, engagement, good listening skills, and professionalism. It may take some time to adjust to this method of “eye contact” but do your best and be sure to make sure the patient knows you’re engaged, and don’t be afraid to look at them on your screen from time to time if they are physically emoting or showing you something. Engagement in your Telemedicine call is going to be vital and your patient will be happy to know that they are genuinely being listened to.

Body language: Now that you have mastered “eye contact,” let’s talk a little bit about body language and facial expressions. We all know that meaning can be lost in translation in a phone call or text message so it shouldn’t be surprising that certain cues and warmth are often lost via video. Everything is going to be exaggerated on a call; when you relax your face, frown, pause to listen, or glance away, it may come across as disinterest, annoyance, or even anger. So take care in your expressions. Take a moment to observe yourself during a call and glance at your own video box to see what your face and expression look like. Be sure to smile and maintain a warm expression so that your patient feels comfortable and at ease. Some patients may be afraid of conducting a visit over a video call because it feels so impersonal, so taking extra care to show happiness through your facial expressions and body language can help produce a relaxing, safe atmosphere. The comfort of your patients is important.

Virtual bedside manner: Creating a comfortable atmosphere to conduct your visit is just as important as it is in-office; think of it as bedside manner. Make sure you ask for your patient’s consent to conduct the exam and consultation via video. If they do not feel comfortable doing so, ask if there is a way you can ease their concerns or offer to reschedule for an in person visit. Since you will be taking notes, updating charts, glancing around, and doing other things on your end of the call, be sure to always let your patient know what you are doing, so that they know they aren’t being ignored. Simply stating that you will be taking notes as they describe their symptoms, or that you will be glancing at charts, is enough to show active engagement. Over explaining isn’t a bad thing here as you want to avoid miscommunication, whether that be verbal or visual. Balancing documentation, eye contact, and demonstrating active listening may be difficult, but your efforts are greatly appreciated by your patients.

Patient performed exams: When your Telemedicine visit reaches the point of the exam, it will have to be self conducted by the patient. This step will require very specific, clear instructions so that the exam is not only performed correctly, but so that the patient confidently feels that they know what they are doing. Use precise language and visual instructions. Demonstrate on yourself if possible and walk the patient through the process of the exam. As they proceed ask them what they are feeling and offer a few descriptors to help accurately decipher their symptoms. Since this is a Telemedicine visit, the appointment will be more condensed and efficient, so getting as much information out of the exam as possible is important. The patient would likely rather be asked too many questions than too few and feel as though they didn’t convey themselves enough. Once you feel you have asked enough questions, conducted a thorough exam, and taken notes it’s time for the diagnosis and next steps.

Diagnosis: A firm diagnosis may be difficult over video so some patients may require further examination in person or additional testing. Go over your notes and talk with your patient about what your possible diagnosis is and the next steps to take. Summarize the visit, let them know all of your opinions and potential options, and come to a shared conclusion. A shared decision may not always be easy, but listen to your patient and make them feel comfortable about their options. Lastly, for the ease of your patients create a clear set of instructions that can be accessed through
the Patient Portal. Only about 10% of what is said during an exam is retained so this will ensure that the patient is at ease, knowing they have a guide on what to do next after the call has ended and can still ask questions. The more resources the better.

Wrapping it all up: Now that you’ve said your goodbyes and closed out of your Telemedicine appointment, you can rest assured knowing you’ve conducted a successful, fruitful consultation. Keep these tips in use as we continue to evolve into a more and more digitized medical world and you will be sure to maintain a professional, productive practice.