Best practices for telehealth center on comfort, aim to empower patients

Key takeaway:

• To maximize the benefits of telehealth, a presenter described the best ways to set up a virtual exam, build trust with a patient and guide them through a physical exam.

SAN DIEGO — A presenter at the 2023 ACP Internal Medicine Meeting shared some best practices to maximize the benefits of telehealth.

“If we ourselves aren't comfortable on camera taking care of our patients and we ourselves are uncomfortable with technology, patients aren't going to feel comfortable and they're not going to have the faith in us to listen to us and what we have to say,” Neel Naik, MD, an assistant professor and director of emergency medicine simulation education at Weill Cornell Medical College, said in his presentation.

The first tip Naik offered was setting up a virtual exam. He said that physicians should know the system they are using and how to troubleshoot it, both on their end and on the patient’s end. However, setting up a virtual exam also includes preparing patients for a medical experience.

The setup of an exam room “gets the patient in the mindset that they’re about to have a medical exam,” Naik said.

“We do that with signage ... outside the building. They get greeted by someone. They fill out some forms. By the time they get into the room, they're prepared to have a medical visit.”

With telehealth exams, patients are popping up on camera from wherever they choose and are not always “mentally prepared to have a medical encounter.”

To combat that, physicians can set up their own space thoughtfully — perhaps even conducting a telehealth visit from an exam room — and wear their white coat and nametag.

“Set up your background to be either positive or neutral and make sure that you are framed in the center of the picture, you have adequate lighting so they can interpret your facial expressions ... and that you're looking into the camera, which is the equivalent of making eye contact,” he said. “Those are all things you can do before the visit to set up that medical space.”

Another tip Naik shared was building trust with patients. It is important to know who is in the room with a patient, but it is also important for physicians to be transparent about who is with them, whether it be a scribe, medical student or another provider.

“If, all of a sudden, someone comes into the room that they were not expecting, it destroys some of that privacy and destroys some of the safety of the environment,” he said. “You want to make sure that you build that safe space so that you can conduct a medical encounter and the patient feels comfortable.”

Finally, he said physicians should work with patients for physical exams.

“You can do a physical exam ... and I would say that it adds a lot to your ability to care for patients and sometimes provide a better plan,” Naik said.

Naik explained a guided self-examination, the same method he uses with medical students and residents when teaching them how to conduct a physical exam. He has been successful with this tactic, diagnosing some appendicitis cases and using the information to better inform his discharge instructions.

“Let's say they weren't tender, then my discharge instructions all of a sudden become ... ‘every hour I want you to repeat what we just did on camera, and if at any point in time you feel pain when you push, I want you to give us a call back or I want you to go to the emergency room,’” he said. “Now I'm empowering my patient to take care of themselves, and I'm really partnering with them to perhaps do the next level of care beyond the visit that I just had.”