- Not every doctor can “do” telehealth.
As more and more health systems adopt audio-visual platforms and train their doctors and nurses to use the technology, they’re discovering one little problem: One’s “bedside manner” doesn’t always translate to the video screen.
"You can be a great physician and not be a great telemedicine physician," Randy Parker, CEO of MDLIVE, a Florida-based telehealth provider, said in a 2105 interview. "You need a 'desktop manner.' It's a different level of skill that you never learned in medical school."
Unlike a trip to the doctor’s office or hospital, a video visit is limited to the screen space in a desktop PC, laptop, tablet or even a smartphone. That’s the only window a clinician has in connecting with a patient, establishing a rapport and making a diagnosis. If that connection isn’t made, if a patient doesn’t like what he or she is seeing or hearing, the diagnosis could be wrong.
"There's a whole comfort level and professionalism involved [in telehealth] that many doctors don’t get," says Parker, who estimates that about half of the nation's doctors aren't getting it right. "There's even a dress code, and a way you present yourself" in a video encounter.
Telehealth vendors like MDLive, Teladoc, Doctor on Demand and American Well often spend a lot of time training their clinicians on how to conduct virtual visits. And universities and teaching hospitals are getting into the act as well, offering courses on telehealth presentation that separate the technology from the technique.
In a blog posted in 2014, Bret Larsen, CEO of Phoenix-based eVisit, offers five recommendations for clinicians getting ready to go online:
- Address patients by their names. That starts the conversation on a less formal, more personal tone and establishes that this visit isn’t all about numbers. A patient will feel more comfortable – and more open – if his or her first name is used.
- Introduce yourself and explain your role. Just as the physician wants to know all about the patient, that patient should know a lot about the physician as well. This improves engagement, making the patient feel more like a contributor to his or her health management. If the patient can’t remember the doctor’s name after the video consult, the connection is lost.
- Don’t cut the patient off. Studies have shown that patients take an average of 32 seconds to state their health concerns – yet physicians, on average, cut in after 20 seconds and redirect the conversation. If a patient has a story to tell, let him/her. There may be more in that story to help the diagnosis.
- Validate the patient’s concerns. A patient’s concerns are real, and should be given the doctor’s full attention. Even if that patient self-diagnosed after a trip to the Internet and is wrong, the symptoms are still there. Hear the patient’s story, then gently turn the conversation toward the right diagnosis without being dismissive or condescending.
- Don’t be afraid to admit you need help. Patients may expect that a doctor will know what needs to be known to make a diagnosis, but that’s not always true. It’s better to admit that you need to do some research or consult with a specialist. They’ll appreciate the honesty and will feel more confident in the end result.
Some physicians have had a hard time adjusting to virtual care because the dynamics of the doctor-patient relationship are changed. With an in-person consult, the doctor is more in charge, an authority figure in his or her own environment. But with telehealth, that doctor is stepping into the patient’s environment.
"The whole concept that has changed is patient satisfaction," says Parker. "It's customer service, something they may never have thought of before, but it's big now. Consumers have more money in the game. It may be more than just a small co-pay, more like a high deductible, so they want to make sure they get it right."
Some organizations are only now realizing that telehealth is a whole different ball game, and one to which clinicians may need help adapting.
At this year’s annual meeting, the American Medical Association amended its policies to recommend that medical students and residents train to use telemedicine – part of a contentious, years-long debate over how doctors should use telehealth and how it might affect the doctor-patient relationship. The AMA is working with more than 30 of the nation’s medical schools to make sure tomorrow’s clinicians know how to use the technology.
"The vast majority of medical students are not being taught how to use technologies such as telemedicine or electronic health records during medical school and residency,” Robert M Wah, MD, the AMA’s immediate past president, announced in a press release. “As innovation in care delivery and technology continue to transform healthcare, we must ensure that our current and future physicians have the tools and resources they need to provide the best possible care for their patients. In particular, exposure to and evidence-based instruction in telemedicine's capabilities and limitations at all levels of physician education will be essential to harnessing its potential."
But proficiency with telehealth goes far beyond knowing which buttons to push. And some who have been in the industry for a while believe proper online care won’t be learned in a school.
“[This] isn't necessarily something that can be taught," says Ryan McQuaid, CEO of PlushCare. It requires a certain kind of innate skill to project over a video screen or through an e-mail/text encounter, not unlike acting.
"You have to be outgoing, and comfortable with technology," McQuaid says. "Certainly there are doctors out there who are amazing physicians when dealing in person with a patient, but they just don't do well" in a telehealth setting.
"You can't just connect with anyone," adds HealthTap CEO Ron Gutman,noting that online care might be more quality-intensive than in-person care because of the challenges of dealing with a patient in a different location. "You have to understand the dynamic."
Abraham Verghese, of the Stanford University School of Medicine, says an online doctor needs to make the encounter personal.
“A very important, I would say ministerial, function of being a physician is to be attentive, is to be present, is to listen to that story, is to locate the symptoms on that person of that patient, not on some screen, not on some lab result, but on them,” he said during a 2015 PBS Newshour interview.