At the beginning of the Covid-19 health crisis many clinicians (physician and advanced practice providers) were unceremoniously thrown into the world of telehealth. With a highly-infectious deadly virus rampaging through our community, the question was not about whether telehealth was good or not. It was about getting care to patients and keeping healthcare staff safe, especially during times of personal-protective equipment shortages.

All providers stepped up to the challenge, though some were more enthusiastic about using telehealth than others.

What most were lacking though, was a quite simple, but very important orientation on the “webside manners” of telehealth. Most were given a webcam, a Zoom, Facetime or account and told: Go! Do Telehealth!

While doing telehealth well is quite easy, many of the subtle aspects of “delivering care at a distance” at the same level of quality as an in-person visit are not that obvious. Which is were training on some basic “webside manners” can help tremendously on many levels – and provide a 10-fold Return or better on the investment to help clinicians to master their webside manners.

This article is part of a 2-part series and in today’s part I’ll be covering the first set of the webside manners and the first set of benefits.

Webside Manners, defined

Obviously the term “webside” manners is a play on words of the commonly known “bedside manners” that, as we have learned over the past decades, have an important effect not only on patient satisfaction or (averted) malpractice suits but also on patient engagement and outcomes.

While every clinician should be well-versed in proper “bedside” manners (even in the outpatient, ambulatory world) extending the proper tone and communication to the “virtual” world can be non-intuitive.

Here’s a list of the first 5 of the 12 aspects of optimal communication, that we have helped clinicians to master to maximize their “performance” in the telehealth world:

1. Eye Contact for the first 30 seconds

To look directly into the lense of your webcam at the beginning of a visit is absolutely crucial and may be the most disorienting, uncomfortable new habit to adopt to. By looking into the lens, the patient on the other end will feel as if you are looking right at them. If you are looking down at their face on your screen, you appear not to be looking at them. As the saying goes “you only have one chance to make a first impression” and by opening up the visit with your introductory words while looking directly into the lens you will set the tone for the visit.

2. Acknowledge the Background

Interacting via video is new to many of us, especially for something as intimate as talking about our health. To build rapport and to get over the awkwardness of this new experience, it is important not to gloss over the aspects that are so different from when patients come into a clinic. In a clinic environment, we are meeting either in sterile, spartan exam rooms or in lavishly decorated (mostly diplomas) physicians offices.

Now, for a telehealth visit, the background, what’s behind the patient and what’s behind the clinician, suddenly warrants noticing. As a clinician you may comment on your view behind you, but even more so, you want to acknowledge the patient’s location — and also, as appropriate, thank them for “inviting you into their personal space”.

Since house visits are no longer the norm, it is quite unusual for a patient to allow a clinician into their home. To set the appropriate boundaries and trust, it is thus important that clinicians acknowledge the situation by commenting on the patient’s background, where applicable.

3. Acknowledge Noise

Not only is acknowledging the visual background important, but it is also important to notice and acknowledge any background noise – on either end. A noise at the patient end may be an indication that the patient is not alone and that the privacy of the visit is in jeopardy. Background noise may also distract the patient or the clinician.

We often suggest that the nurse setting up the visit advise the patient to use a headset or headphones to at least ensure the confidentiality of the physician’s comments; but oftentimes, especially in behavioral health, it is also important that the patient’s words can stay private.

For noise in the background coming from the clinician’s end, since the patient cannot see what is going on or who else may be in the room (which should not be the case), it is important for the clinician to note any voices coming through the door or other sounds that may distract the patient from listening to the clinician.

4. Acknowledge Novelty

While by now many patients (and clinicians) may have had a telehealth visit, it is still a good practice to acknowledge the novelty of telehealth and how this is “out of the ordinary”. With the physician self-disclosing that they themselves experience telehealth differently, they allow patients to admit and disclose the same, thereby strengthening the trust.

5. Acknowledge Benefits

Finally it is a great practice to also acknowledge how great to have telehealth as a tool available to continue to care for patients, especially those for whom it would have been difficult to get to a telehealth appointment.

When you compare access to care via telehealth to no access to care, telehealth beats no care every time.

Next week, we’ll review another set of webside manners and best practices to ensure a great experience for both, patients and clinicians.

The Benefits of Excellent Bedside Manners

One of the biggest returns of investment I have seen when investing in enabling clinicians to master webside manners is in the clinicians confidence to operate on top of their skillset, even though the environment is very different from what they were used to for 10, 15, or 25 years.

Physicians go through a rigorous, regimented training that most of the time has them learn from and under the supervision of the previous generation. From my user experience design perspective, it is important for the well-being of the patient that the physician exude a high degree of confidence. Having an ailment, receiving a diagnosis or receiving care can be a very scary experience and knowing that one is “in good hands” by a doctor that is confident in their abilities, confident in their assessment is reassuring and a critical component of care and healing.

Thus when clinicians cannot be completely confident because they are outside of their comfort zone there are numerous ramifications. I have seen it over and over again that when clinicians are not comfortable “in front of the camera” the patient satisfaction scores are typically very low (as are of course the clinician satisfaction scores).

Conversely, after we worked with clinicians on a basic webside-manner orientation, their level of confidence increased dramatically and so did the patient satisfaction scores. Increasing proficiency through webside-manner training is therefore the linchpin to telehealth success and all of its other benefits, which we’ll discuss in part 2 next week.

Which webside manners matter to you?

Before we continue next week, let me know what webside manners you have adopted or deemed important in sharing with your clinicians.

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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.