I’ve long held the belief that the most significant difference between a great and a bad telehealth visit is the clinician attitude. Which probably also holds true for in-person visits as well. A clinician with bad bedside manners is never going to make you feel good or better, than an empathic doctor who takes the time to listen and shows they care.

In one of my searches of #telehealth on LinkedIn, I recently discovered a great interview series in the Authority Magazine published on Medium. Since April 2021, the magazine has interviewed over 175(!) clinicians and healthcare leaders on “How to best care for your patients when they are not physically in front of you.”

In the structured interview of about 15 questions, the Magazine’s interviewers dive into the background of the expert, ask them to contrast in-person vs. telehealth, list the 5 things to know to provide the best care telemedically, and provide an outlook to the future.

After browsing through about a dozen of interviews, here are the key common themes mentioned by most of the telehealth-experienced clinicians:

Theme 1: Ensure an Optimal Patient Environment

Poor connectivity, poor video quality, poor lighting, and poor audio can all greatly diminish the quality of a telehealth visit. Any interruption on the call quality (such as lag) can lead to missing “diagnostically important details” or a poor patient experience.

Beyond the technology it is even more important that patients are in a quiet space that ensures privacy, with no colleagues or family members to eavesdrop. Sometimes this requires pausing or ending a telehealth visit if a patient is found to be walking around the store, in a restaurant, or — even worse — driving. Wait until the patient is in a private, secure location before commencing the visit.

Theme 2: Professionalize the Clinician’s Environment

The obvious aspects here are professional attire (from head to toes!), good lighting, a professional background, and a well-framed camera angle. But it’s also important, even if it does not show up on video, to clear one’s desk from clutter and also remove any “electronic distractions” such as email, text and open browser windows. In the in-person environment there is an advantage to going into an exam room and logging into a fresh computer session. The same “hygiene” should also be practiced in a telehealth environment.

Another word of advice given by multiple clinicians: ensure a quiet, private space with little to no background noise. And if there is a noise, acknowledge it and, if possible, explain it.

Theme 3: Focus on the Whole Patient Experience

It’s important for clinicians and clinic administrators to realize that patients, just as in the in-person world, have to go through a lot of steps before and after the actual visit. From scheduling a visit, preparing for one (e.g., through a Telehealth TechCheckSM), and getting “tele-roomed” to scheduling follow up visits, getting referrals, or arranging for tests such as blood draws, or radiological exams: For a great patient experience, all these steps require a meticulous design of the “proper telehealth workflows”, so that everyone involved in the process understands their role and how to help the patient move “through the system”.

Theme 4: Confirm Telehealth Appropriateness

While a multitude of clinicians agree that a large percentage of in-person visits can be conducted “at a distance” effectively (some putting it as high as 95%), telehealth is not appropriate for every patient and for every condition. In our work with clinical teams we develop a list of “telehealth exclusion criteria” that the scheduling staff can use to triage the patients to the right form of care.

And even if a patient starts out on a telehealth visit, they can, just like in an in-person care visit, still be directed to a different level of care, such as the emergency room, an urgent care visit or even an traditional in-person visit.

Theme 5: Your In-Person Visit Training Still Applies

One pattern that was great to see in the review of the “5 things you need to know to best care for patients when they are not physically in front of you”, is that many clinicians simply pointed out the basic practices of good “bedside manners” and best practices from the in-person visit world: Have access to your patient’s chart. Listen. Then Listen more. Ask “what else?”. Be patient. Be confident in your ability to conduct a telehealth visit.

Theme 6: Make it Engaging by Upping Your Energy Level

Since the camera puts an artificial distance between the provider and the patient, it is even more important to put an extra level of energy into your interaction with your patient “through the lens.” Especially positive facial expressions are important whereas verbal interjections should be kept to a minimum, as they can interrupt the flow of conversation by suppressing the patient’s voice.

Equally important is eye contact (though it was only mentioned infrequently): concentrating on staring into the lens of your webcam (vs. the patient’s video) is especially important in the first 30 seconds of your visit to quickly establish interpersonal rapport.

Theme 7: Practice Remote Physical Exams

While not ideal, much can be learned from even a remote virtual exam. From heart rate to gait, from range of motion to abdominal pain – many aspects of a physical exam can be conducted virtually, the goal being to get “enough information to know what to do next”.

However keep in mind that “a detailed history, taken by an unrushed clinician, is more useful than a physical exam.” Physical exams, even in the in-person visit world, are rarely absolutely conclusive and most of the time further tests are ordered to confirm a preliminary diagnosis.

Best Practices to Implement the Themes

Most healthcare organizations by now have established a team of designated, experienced telehealth support staff that can help clinicians and patients to have a great telehealth experience any time. For organizations that don’t have that level of expertise in house, boutique consulting firms like ours can assist in implementing the basics and pass on their expertise to your staff.

Here are our proven telehealth optimization interventions to achieve these themes in your telehealth visits.

Telehealth TechCheck: The best preparation of a patient for their first telehealth visit is a quick phone and then video call with an experienced and personable telehealth support staff to conduct a TechCheck. Here’s an article with more information about that process: “Telehealth TechChecks – Rocket Fuel for Telehealth Success”.

Telehealth Workflows: Clarity for the providers, the schedulers, the nurses, and the patients on what to do is key to creating a great patient and provider experience every time. We’ve identified 7 Telehealth Workflows that every clinic must define to deliver the best patient care experience.

Webside Manner Training: Bedside manners for the web world is a training that every organization should invest in. From handling interruptions and background noise to eye contact and establishing rapid rapport with the patient through high energy presentation — a good training will cover all the proven tips and tricks and provide ample opportunities to practice in a safe environment. The training should also address the best (and approved) practices for setting up a clinician’s telehealth station. Here’s our white paper on “The 10-fold return on Mastering Webside Manners”.

Virtual Exam Training: Many high-caliber organizations (especially renowned academic medical centers) have developed numerous protocols to effectively conduct virtual exams and to appropriately document the findings in the patient’s chart. When you are expanding your primary care or urgent care practice into the virtual care world, investing in this training will pay large dividends.

Virtual Visit Exclusion List: As mentioned above, we recommend that all of your clinicians reach consensus and develop guidance on what conditions or chief complaints are NOT appropriate for virtual care. Similar to the criteria for “hang up and call 911”, these symptoms are indications of a higher severity that warrants an in person exam – or quick access to lab results.

A Telehealth Policy: Finally, a good and constructive telehealth policy does not only cover the basics of licensure and consent, but also addresses conduct, documentation requirements, crisis response policies, professional behavior, telework, etc. This article includes a starter list of what to cover in a Telehealth Policy.

Overcoming Clinician Hesitation

It is understandable that many clinicians still are hesitant to fully embrace virtual care delivery to the extent that it could be (and eventually will be practiced). It’s not what they learned in medical school and most likely was not taught by their preceptors and mentors.

But reading through the 170 interviews of clinician leaders practicing telehealth it should become evident to providers, that virtual care is not some esoteric Covid-19 health crisis stop-gap measure, but actually a care delivery change to be reckoned with.

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Christian Milaster and his team optimize Telehealth Services for health systems and physician practices. Christian is the Founder and President of Ingenium Digital Health Advisors where he and his expert consortium partner with healthcare leaders to enable the delivery of extraordinary care.

Contact Christian by phone or text at 657-464-3648, via email, or video chat.