Communication Tips for a Good Telehealth Patient Experience

Look the part

A telehealth care encounter may be new for patients, and they want to know that the quality of the care they will receive is on par of that delivered on an in-person basis. The first step for that is looking the part.

“This is why you should wear a white coat,” Thomas Lee, MD, CMO at Press Ganey and a primary care doctor at Brigham and Women’s Hospital, said in a previous interview with PatientEngagementHIT. “This is why you should actually have your necktie on if you're a man and you should have the necktie knot all the way up. You should not be looking like you're George Clooney in a TV show or something. Show you can do things to inspire confidence.”

And although Lee was referring to appearance during an in-person encounter, these principles carry over. Dressing the part will go a long way in instilling confidence in a patient receiving care via telehealth, especially for the first time, as will using body language.

According to Jonathan Mack, PhD, RN, NP, and the director of a telehealth training program at the University of California San Diego, body language carries over on the camera.

“We teach clinician students about physical appearance on camera,” Mack said in a past interview.

“We teach them about physical cues because a lot is lost in a telehealth visit that isn’t lost when you are in person,” he added. “However, we can generally mirror in-person interactions if we teach clinicians the proper behaviors, such as looking into the camera, not taking notes, making sure that you're dressed appropriately, and ensuring the environment is appropriate so there aren’t distractors for the patient.”

Be prepared

Part and parcel with keeping up appearances is being prepared for a telehealth visit. The telehealth environment needs to have all of the tools necessary for conducting the visit, according to Mack.

“We now have the ability to do very limited physical exams through the use of peripheral technology,” he said. “We can actually look in the back of someone’s throat, we can look in their ears, listen to their heart and lung sounds as well as their abdominal sounds. That pushes the capability of the visit.”

USD trains providers to be fully stocked of these additional remote care tools, as well as trains them in how to use them. Although the technology training is less extensive than the interpersonal lessons USD reviews, it is still essential providers know how to use Blue Tooth and other technologies to allow for a more seamless care encounter.

But preparation goes beyond lining up a telehealth provider’s suite of tools, Esher-Blair from Arizona Telehealth Program wrote, although that is important. Clinicians delivering care via telehealth should be prepared with the following:

• Equipment – understand how to use and test; know who to contact to troubleshoot; ensure good placement of camera, microphone and speakers
• Physical space – clear of distractions; good lighting; private and secure (HIPAA)
• Provider Appearance – professional; solid, non-distracting (preferably light blue) colors
• Preparation – review patient history chart/file

Importantly, this includes preparing the optics in the telehealth exam room. Researchers from the Arizona Telehealth Program conducted research on the matter, concluding that the way a provider’s practice environment looks is essential just as it is during an in-person visit.

“In telemedicine room design, the challenge is to incorporate communication technology into medical practice to facilitate efficient communication,” the researchers wrote. “If this is done properly, the technology becomes unnoticeable to those involved in the telemedicine interaction.”

Providers conducting telehealth may consider the following:

• Whether doors are visible. Doors in the shot might be off-putting for patients who are concerned someone could walk in and disrupt the encounter or overhear sensitive health information.
• There is enough lighting in both you and the patient room.
• There is limited ambient noise and microphones are working on both ends.

This will be especially important for providers who may be delivering telehealth from their own homes. Clearing clutter, setting up adequate broadband connecting, and creating a more clinical looking space may help establish confidence in patients.

Establish rapport, communicate empathy

Perhaps most challenging will be creating a warm and inviting feeling during the telehealth care encounter. While the clinical quality of care may be equal to or better than care delivered in-person, patients may still perceive pitfalls if the connection they make with providers is strained or forced.

This poses a threat to the entire telehealth experience, however, because it can be challenging for providers to make their empathy known and felt with a literal computer screen separating them from their patients. The short duration of telehealth visits can also be limiting.

“Telehealth visits may not be any longer than ten to fifteen minutes. So, establishing a rapport immediately is important,” Mack asserted. “People tend to look down at the screen during video calls, so that translates to someone on the other side as not maintaining eye contact. The clinician needs to be trained to listen and look into the camera because that's what's going to appear on the screen for the patient as though the provider is looking at the patient.”

In other words, looking at the webcam on the computer, not into the patient’s eyes as they are shared on the computer screen, will be important for establishing a connection with patients.

Providers also need to focus on what they say, not just what they do, during a telehealth encounter. Strong patient-provider communication skills and empathy will go a long way in driving satisfaction with the telehealth encounter.

“Empathy is no less important in telemedicine,” Esher-Blair wrote. “Being prepared, clearly communicating, and focusing on your patient will help foster a positive patient-provider relationship.  You can still make meaningful eye contact via telehealth, but the trick is looking directly at the actual camera, and not the projected image of the patient on your screen.”

This will include using any communication strategies that are typically successful during in-person encounters, like introducing oneself as the provider and making a non-medical connection with the patient.

Telehealth providers can also explain how they are taking notes during the care encounter and solicit patient questions where applicable.

Telehealth is slated to reach a broader audience during the industry’s efforts against the novel coronavirus. Under strict social distancing protocol, patients and providers alike are encouraged to use telehealth to conduct some COVID-19 screening, deliver mental healthcare, and continue chronic disease management.

Reviewing communication best practices will help providers maintain a high level of patient satisfaction with their care, even as that treatment transitions to a digital format.