CMIO CT Lin on Improving the Telemedicine Encounter

We have a global pandemic. There are daily policy changes. We work from home, have new video tech, and we are learning to communicate and build relationships in new ways. It is easy to forget that there may be a scared patient on the other end, counting on us. How might we improve the patient experience?

Below are some ideas.

Secure Chat with Your medical assistant (MA). Scrub your schedule together, days ahead for patients more appropriate for telehealth vs in-person visits, med rec, troubleshooting, visit focus.

Arrange your room and self. See tip sheet in Epic (“Demonstrate Professionalism”). How is your room? Your light? Your clothing? For me, the new normal means no white coat during virtual visits.

Eye contact – put a sticky note on PC cam to “Look here!” Arrange the camera at eye level if possible. For some, looking down = frowning? Eye contact on video visits is even more important. “If I look away, it is because I’m looking at information in your chart.”

Avoid running late. If you do, inform your MA by Epic secure chat, and they can inform patient.

Greet the patient. I like to raise my arms in surprise when we connect: every human connection now, is amazing. Maybe thank them for connecting with you. Ask if they’re in a safe, private spot (eg: advise patient NOT to be driving!)

Talk, human to human. Ask things like, ‘how are you coping (aside from medical concern)? Scared? Worried?’

Reflective Listening. Even more important now in this time of anxiety. You can reflect or say back Data, Ideas, Feelings, and Values. It strengthens connection. For example, data: “It has been 5 days of worse symptoms?” Ideas: “So you think it might be gout?” Feelings: “You’re worried about work? Hmm.” Values: “So, what’s important to you is your family.”

PEARLS. Some clinicians may have taken the Excellence in Communication course. The PEARLS acronym can also be helpful. Here are some examples. Partnership: “We’ll get through this together.” Empathy: reflective listening (see above). Apology: “I’m really sorry that happened.” “I’m sorry for my part in it.” Respect: “You have worked really hard on this.” Legitimization: “Anyone in your situation would feel that way.” Support: “My team and I are here for you. We aren’t going anywhere.”

Physical Exam creativity. Teach them to take a pulse: “say beep when you feel it” and you can count. Patients may have a BP cuff, Pulse ox, flashlight, or thermometer.

Ask for help from family. Others may help add to history or exam findings.

They may ask about YOU as a human. “How are you, doctor? Are you staying safe?” So many surprising comments from patients worried about their doctors. Thank them!

Brief LIFE advice. During the pandemic, consider: A) Limit news/social media to 30 minutes per day. B) Exercise daily. C) Try the three good things exercise, proven to reduce depression and anxiety if done consistently. “What 3 things are you grateful for today?” Can become a great family habit at dinner.

AVS and Open Notes. From My Health Connection, they can see your AVS (after visit summary) and your Progress note (called Clinical Note) to remind them of details of your visit. Maybe at end of visit, ask: “Sometimes I don’t explain myself well. Can you tell me what you’ve heard, so we’re on the same page?”

Reassurance and Hope. “We’re going to get through this!” “Stay in touch with your loved ones.”

Ending the visit. Consider doing a hand wave, palms together, nod, thumbs up, “You Got This!” Forecast next steps or if your MA is calling them after.

Secure chat with your MA. Handoff any items after the visit for continuity (referral, next visit, lab, etc).

To view this page as a PDF, click here.

And, here is how our Medical Office looks now, deconstructed. One part is in my basement …

And here’s Medical Assistant Becky, hard at work keeping both the patient and the doctor on track at her home. That virus has got no chance against us.

CMIO’s take? Hang in there! You Got This!

This piece was originally published on The Undiscovered Country, a blog written by CT Lin, MD, CMIO at University of Colorado Health and professor at University of Colorado School of Medicine. To follow him on Twitter, click here.


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