virtual visit
Jonathan Chao sees patients virtually at Westridge Health Center.
Marcie Hopkins, U of U Health
improvement
How to be a Virtual Clinician
Virtual care is the way of the future. How do clinicians trained in a face-to-face world transition their skills for a virtual care environment? Physician assistant Jonathan Chao shares three ways Urgent Care delivers expertise and compassion in a virtual world.
W

hen University of Utah first experimented with virtual care in 2016, they asked me to see virtual patients at Redstone Health Center. Initially, I was very skeptical. In medical training, they teach you the importance of checking vitals even before you see the patient. We give it the name "vitals" for a reason. It was very daunting, initially, to take care of patients without vital information.

We learned together, as a group, how to handle medical issues via virtual urgent care. What’s been important is that we have support from Aaron Campbell and Traci Wood, our medical directors. As long as we have good clinical reasoning, whether we treat someone virtually or they come in physically, our leadership supports us. It makes it easy for me to practice medicine how I want: following guidelines and doing the best that I can for my patient.

What I’ve learned practicing virtual care:

Patients are the same (for the most part)

Don't believe the hype.

As an urgent care provider, it can feel like there is conflict between doing what is best for patients and making them happy. I wondered if that tension would be heightened in virtual care. I expected that patients would call up demanding things, and if I didn’t deliver what they wanted I would get a bad survey or a bad review.

That fear has turned out to be unfounded. Every once in a while, there is a patient who is demanding. But mostly, patients are grateful that I could offer a consult or answer their questions.

Care is collaborative.

In my experience, more virtual care patients have done some research of their own. They’ll say “This is what I have and this is what I expect to be done.” Once I explain my clinical thought process and tell them what I think, they are open to options. I've learned most people need someone to listen and hear their ideas—they want a collaborator.

Virtual care isn't always the right solution. Sometimes I'm not able to provide the service that they wanted, whether it's a medication refill or starting a new medication. It makes a big difference when I take a moment to explain why I'm not able to give the best medical care in this setting and they usually understand. They follow up with their appropriate provider and it works out well.

Virtual requires deliberate communication

Tone matters.

I’ve thought a lot about how the way I communicate can show patients that I care. In an in-person clinic, I keep track of my body position relative to the patient. I give patients a supportive pat on the shoulder to let them know I’m concerned. Bedside manner is just as important on a virtual visit, but it has to be communicated differently. I focus more on my tone of voice. I try not to sound rushed. I try to keep my voice even and calm.

Motions and voice are more exaggerated.

I make my motions and voices more exaggerated because I worry some of the more subtle nods and reflections of in-person communication will get lost, especially if there is a poor internet connection. Instead of just saying "mm-hmm," I nod my head and speak up louder. I want patients to know I'm not disinterested.

Always start positive.

I’ve also changed the way I communicate wait times with patients. In an in-person clinic, they can see that we’re busy because of the line. When I see a patient virtually, I already know they have been waiting, but it’s different to wait at home than in a clinic waiting room. They’re just waiting blindly when they wait for us virtually. When I sign on, I used to say “I’m sorry for the wait,” or “sorry for taking too long.” That just felt negative. I learned that I could turn the words around. Instead of saying “sorry” I say “Thank you for your patience. I really appreciate that you waited for us.” This simple reframing helps to start out positive.

Virtual care is easier for patients

Keeping patients at home makes life easier for both patients and for us. Flu season is about to start, and if a patient calls in with fever, body ache, and dry cough, I think, "Great! Thank you for not coming into the waiting room and infecting everyone." We still talk to them about the risks associated with medicine or sometimes guide them to come in. I see a lot of moms with toddlers on virtual urgent care—it’s great to keep them at home and not disrupt their day.

These visits allow us to do what's easier for patients, and I get to do what I most enjoy—solving patients' problems. I love the diagnostic part of medicine. The detective in me loves to figure out what is going on from clues. I like trying to piece together all of the disparate parts—complaints from patients, images, labs—into a diagnosis. 

One example I share with new providers is about an elderly patient I saw with lower right back pain. I went over the typical questions to help understand if there was trauma, a kidney infection, or a urinary tract infection. After everything was covered, I asked if I could see the patient’s back. With the technology of virtual care, I saw a string of vesicles on an erythematous base. And if you say that to any clinician, they'll say, "Wow that's shingles." It was a perfect use of virtual urgent care visit, something that we could diagnose by seeing it. I sent in her prescription and saved her a trip.

Contributor

Jonathan Chao

Physician Assistant, Urgent Care, University of Utah Health