Four Essentials of Effective Telemedicine

Added on May 4, 2020

By Chrissy Daniels, MS, Chief Experience Officer

AT A GLANCE
– Simple shifts in communication styles can help make telehealth experiences as effective as in-office visits.
– Efforts to convey authenticity and empathy can help physicians build rapport with their patients.

– On the process side, agenda setting and closing checklists help set patients' expectations and provide guidance for after the telehealth visit ends. 

chrissy headshotBecause of COVID-19, patients and doctors across America are experiencing their first telemedicine visit. Despite the obvious differences, telemedicine follows the path of any other visit, with a patient, doctor, problem, and solution. Beyond that, the telemedicine experience is different, yet it can be just as effective as an in-person visit. Once we identify the differences that impact the experience, we can use key behaviors to bridge the gap.

With telemedicine, patients don’t have to leave their home and drive to the clinic before seeing their doctor. They simply open the app and bing! The doctor is there. The downside to this is that most patients unconsciously use the time getting to the office to think about their questions for the doctor. Further, once they arrive, medical assistants ask questions to frame their concerns before the doctor enters. Similarly, physicians often have time before seeing patients to frame their thoughts. Many huddle in the morning with their teams to review the day’s schedule, and most connect with the nurse or medical assistant who gathered preliminary information from the patient, giving themselves time to think about plans for testing, results, and special needs. These small moments don’t exist with telemedicine. Instead, the patient shows up on the screen, and it’s showtime.

In addition, many of the approaches that establish rapport and create comfort during in-office visits are missing from telemedicine visits. There’s no handshake or physical touch, body language is limited, and even those relational questions that physicians use to put patients at ease can seem stilted on a video call, as both doctor and patient get used to talking in turns and not over each other. 

The good news is that none of these changes needs to be a barrier to great patient–physician interaction. If we acknowledge these challenges, we can easily overcome them with four key communication skills and tools: authenticity, agenda setting, empathy, and closing checklists. 

Authenticity

Physicians have always had the benefit of physical connection. We all know the power of laying hands on a person to convey comfort, connection, and caring. Without this accelerator, physicians need to put those qualities more concretely into words—their own words. Incorporating language about thoroughness, caring, and understanding will be an important addition.   

Telemedicine technology can also change how physicians are perceived. It’s not quite the same as being in the room. Following are some tips for making sure these perceptions are as authentic as possible.

  • Be more conscious of the warmth of opening and closing greetings. Starting with a smile goes a long way.
  • At the beginning of the appointment, confirm that the patient can hear and see you clearly.
  • Allow for an extra pause after the patient speaks to ensure they have completed their sentence to avoid interruptions.
  • Explain when you have to look away from the patient to reference the EHR or other documents.


Agenda Setting

Understanding the patient’s priorities and questions up front is an absolute must. Many physicians already embed agenda setting into their daily practice. The challenge here is that your patients may be less “ready” than they have been in the past. Make sure to take an extra few seconds to allow them to think about it. 

  • Identify priorities. “I see that you’re here to discuss your blood pressure. Before we begin, are there any other issues you were hoping to discuss today?”
  • Ask twice. After the patient identifies their concerns, ask “Is there anything else?” and wait for the answer. Keep asking until they confirm that they have nothing else.
  • Negotiate if needed. “That’s a lot to cover in our time today. We may not have enough time to tackle them all today. I do think it’s important to discuss your blood sugar today since it sounds like potentially the most pressing concern. We’ll cover as much as we can in this visit, and we can save anything noncritical for the next visit.”
  • Restate the agenda. “So today we’ll discuss your headaches and blood sugar, and we will save your shoulder pain for the next visit.”


Empathy

Deliberately addressing concerns for patients is important. As referenced earlier, the challenge with showing empathy through telemedicine is not the intention but the limited ability to convey it through tone, pauses, and body language. With telemedicine, one must rely more consistently on conveying empathy through language. It’s surprising, but simply making a commitment to the patient or using more caring language can bridge many gaps. Care providers may need to check in more deliberately about worries or concerns throughout the visit and especially at the close.  

Closing Checklist

Think about how many times a patient remembers a question or request after the physician has left the room. In the clinic, the medical assistant can quickly get answers. But when the telemedicine visit ends, what options does the patient have? Physicians must devote a greater portion of the visit and bring more structure to officially closing out the session. Ideally, the after-visit summary is still the communication tool of choice, but physicians should remind the patient that this checklist is in the EHR portal. They will no longer have the paper copy to reference. The list should cover the following.

  • Summarize the plan.
  • Reinforce any care provider actions, such as calling in a prescription, labs, etc.
  • Reinforce any actions that the patient will take, such as increasing activity, changing diet, and complying with medication.
  • Review questions and answers.
  • Provide guidance on what to watch for should a problem worsen.
  • Offer instructions for follow-up questions or concerns.


Conclusion

The great news is that telemedicine improves with practice, for physicians and patients. Despite the challenges outlined here, telemedicine has amazing benefits for both: eliminating no-shows, late arrivals, and transportation and weather problems; keeping frail patients in the comfort of their homes; and being able to see more about patients’ home lives. The benefits of telemedicine will continue to grow as it becomes a critical tool for care delivery. By adopting these four communication essentials, physicians can make every telemedicine encounter more effective and a better experience for their patients.