Establishing Strong Provider-Patient Relationships Through a Screen

BARRIERS TO RELATIONSHIP-BUILDING VIA TELEHEALTH

Telehealth offers several advantages conducive to building and maintaining strong provider-patient relationships — a fact that clinicians should embrace.

Patients tend to be more comfortable in their own homes and expend less time, energy, and money to attend a telehealth visit, and as a result, patients are more likely to be open and honest during an appointment, said Nancy Papesh, director of clinical operations at The Clinic by Cleveland Clinic, during a phone interview.

The Clinic by Cleveland Clinic is a joint venture between Cleveland Clinic and telemedicine company Amwell. Its primary service is the virtual second opinion program, launched in October 2019.

"Patients that come to us, all we ask is that they have a diagnosis and a treatment plan…so that there is an opportunity for our super specialist to take a look at that, review the diagnosis, review the treatment plan, and provide an educational second opinion for a way forward for the patient," Papesh said.

The virtual nature of the second opinion program has enabled Papesh to identify some of the critical barriers to connecting with patients emotionally and displaying empathy through a screen.

One of the biggest? Clinician mindset.

Clinicians have been trained to use their eyes, ears, and hands to examine a patient physically. And when all of that is taken away, a clinician may feel uncertain.

"I think the biggest hurdle [for the clinician] is just letting go of thinking of technology as a barrier," she said.

Mia Finkelston, MD, a family medicine physician and senior medical director at Amwell, echoed Papesh.

"When I talk to providers before they even do the training and sign on with Amwell, that's one of their first questions — and you can hear the anxiety in their voice — 'how do you do this, Dr. Mia? How do you talk to a patient? You're not getting your vital signs yourself; you're relying on self-reporting, or you're relying on any gadgets they may have. So, how do you deal with all that?'" Finkelston said in a phone interview.

Further, the very tangible barriers to technology access and use can add stress to telehealth visits.

Physicians cited lack of access to technology (69.8 percent) and lack of digital literacy (61.3 percent) as the top two barriers to accessing telehealth, according to a survey conducted by the COVID-19 Healthcare Coalition.

Physicians may worry about what type of video conferencing application or technology to use and what happens if the visit gets cut short due to a technical snafu, Finkelston said.

OVERCOMING THE HURDLES

Comprehensive training is needed to boost confidence and help clinicians effectively connect with their patients through a screen. 

Clinicians working at The Clinic by Cleveland Clinic are provided with various educational modules that go over technology education and key relationship-building tenants, like empathy, Papesh said.

The Clinic conducts technology practice sessions with clinicians, including simulations of situations where technology has gone awry.

"We also do some additional role-playing," she said. "We practice different…challenging situations, and we role-play through those, [and talk about] how we might meet the patient where they're at. That's something that's part of the onboarding process."

Further, The Clinic assesses the needs of different sub-specialties to pre-empt issues that may occur with virtual visits versus in-person appointments.

"For example, movement disorders — one of the main things our provider likes to evaluate is their gait and how they walk," Papesh said. "What we do in those situations is we just have a family member or someone with them to help them walk during the video visit, or we actually just say, 'Have someone take your phone, take a quick video of you walking across the room, shoot us that video.' Just continually thinking of ways in which your sub-specialty expertise can be delivered through digital means [is important]."

Technical training protocols can help clinicians feel more confident about virtual visits, but it is equally important that they, in turn, make patients feel confident, welcomed, and comforted.

"Greet everyone with a smile," said Finkelston. "We try to train our providers to assume that it's the first telemedicine experience for that patient who's calling in and to let them know they can be seen [properly], that they can be heard well."

Also, clinicians should ascertain that the visit is occurring in a private setting or among the people the patient is comfortable with.  

"If someone's clearly not in an office space or their home — if they're in a car, I'll just say, 'Oh, are you alone right now, or is someone else there?' It's just so that they know I'm going to be asking potentially personal things, and they're going to have to give those responses," she said. "And then I also let them know I'm alone."

Another key relationship-building strategy is focusing on the patient and ensuring they know they are commanding 100 percent of the clinician's attention.

Clinicians should close open tabs on their computers and use their hands when they speak to show that they are not distracted, Finkelston said.

"And really listen and give them time to get their story out without interrupting," she added.

Further, clinicians using telehealth can glean patient feedback to improve the visit experience.

The Clinic surveys its patients to understand what they liked and didn't like about their virtual care experience, as well as what could have made it better and factors that could have helped the patient feel more connected, Papesh said.

As telehealth becomes increasingly integrated into care delivery, its use will be inevitable. Thus, clinicians must expect to use it and prepare accordingly.

"Let go of the fear and the mental[ity] that technology is a barrier," Papesh said. "Take time to learn it just as you did in learning your craft or your expertise. Practice it. Do it. And most importantly, at the end of the day, please give your patients grace and give yourself grace. We're all in it together, and we're learning together."