This past October, Dr. Neel Naik, the Director of Emergency Medicine Simulation Education and an Assistant Professor of Clinical Emergency Medicine at Weill Cornell Medicine in New York City, spoke at the American Society for Health Care Risk Management’s (ASHRM) virtual annual conference. In his presentation on telemedicine, he made several interesting points:
Physicians do not understand how to engage with the patient
Physicians do not know how to present themselves to patients
Physicians do not know how to conduct a virtual physical exam
Dr. Naik went on to say that “physicians must alter their 'bedside manner' from traditional in-person care to better accommodate patient needs during video-based telehealth visits.” Yet, this important skill is often not taught.
If this is the case, then many CAP physicians must be struggling to conduct a telemedicine visit with their patients. Members may be at increased risk for patient complaints to insurance companies and/or the medical board. It’s also important to know that telemedicine is a form of healthcare delivery and the standard of medical care provided to patients is the same whether you see them in person or not. Therefore, if an appropriate exam is not performed during a telemedicine visit, claims may arise from misdiagnosis and treatment errors.
To ensure your patients have an optimal virtual experience and best possible medical outcomes from their next telemedicine appointment with you, CAP recommends the following tips:
Prepare: You want your patient to have the utmost confidence in you. Know in advance why your patient is scheduled. Read the chart before your video encounter. Have a plan of action.
Time: Don’t be in a rush. Your patient will feel unimportant and you’re likely to miss important clinical details. Schedule the appropriate amount of time for each patient. Allow time for questions and be aware of “the doorknob phenomenon.”
Location: Follow privacy and confidentiality rules. Choose a quiet, private location with a neutral professional background. Remove distracting or inappropriate items. Encourage your patients to find areas in their homes to interact privately with you.
Technology: Ensure that your technology works correctly. You don’t want to delay or cancel your patient’s appointment because your system is not functioning properly. Check your camera, your computer, your microphone, your speakers, and your internet connection. Then, check it again. Use healthcare-specific or end-to-end encryption platforms. Have IT on speed dial.
Lighting: Poor lighting conditions have an enormous effect on video quality. You want to look your best and allow your patient to see your face clearly. Use natural lighting. Face the window — never sit with your back to a window. If you do not have a window, find a soft light to put in front of you.
Camera: Avoid unflattering and awkward angles by framing the camera correctly. Place the webcam at eye-level and position yourself so that you are in the center of the patient’s screen. Avoid embarrassing situations.Remember, the camera may still be on.
Sound: Most microphones pick up background noises that can be annoying or distracting. Use quality headphones/earbuds to improve hearing. Mute yourself when your patient speaks. Recognize that there is generally a slight delay between the time words are spoken and when they are received. Avoid talking over your patient. Caution: Hot mics!
Appearance: Present yourself as if you were in the office exam room with your patient. Introduce yourself and your role. Wear your white coat and badge or medical professional attire. Be mindful of your body language. Avoid distracting behaviors, such as excessive gesturing with your hands and facial expressions.
Engage: Confirm your patient’s identity. Smile. Pay close attention to your patient and actively listen. Participate completely as if you were physically in the same room. Minimize distractions and avoid disruption, such as email/message notifications or phone calls. Look into the camera to maintain good eye contact. If you need to look away to take notes or consult a resource, tell them so they don’t think you are doing other work.
Collaborate: Guide your patient through the visit. Have the patient adjust lighting and camera, if needed, for closer inspection. Demonstrate and coach your patients to assist you with their physical examinations. Have them use their thermometers, blood pressure cuffs, and other medical tools to gather additional clinical data.
Close the Loop: Document the telemedicine visit in the medical record. Send a visit summary along with written next-step instructions to the patient.
Resources: For more in-depth information about telemedicine and webside manner, please visit these websites:
California Medical Association (CMA) www.cmadocs.org
American Medical Association (AMA) www.ama-assn.org
Medical Group Management Association (MGMA) www.mgma.org
Additional references are available upon request. If you would like to speak to a CAP risk manager, call 800-252-0555.
Amy McLain is Assistant Vice President, Risk Management and Patient Safety for CAP. Questions or comments related to this article should be directed to amclain@CAPphysicians.com.