asset 3
Marcie Hopkins, U of U Health.
improvement
How to Rapidly Become a Virtual Clinician
Many clinicians and patient support departments are taking a dive into virtual care. Whether by telephone, video, or chat, providers who never envisioned themselves as virtual clinicians are now suddenly just that. Veteran virtual clinician Jonathan Chao and new virtual provider Karly Pippitt share their experiences with what works.
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t’s easy to jump to the technology when talking about virtual care, but really, it begins with the same one-to-one clinician-patient connection.

I’ve been providing virtual urgent care at Redstone Health Center since 2016. Initially, it was challenging, but as as a group, we learned how to handle medical issues virtually. 

Today, providers don’t have the luxury to learn over time. But analog and virtual visits share a common theme: we use good clinical reasoning, whether we treat someone virtually or they come in physically, and regardless of the technical connection, we connect with the human first. 

 Here’s what I’ve learned practicing virtual care.

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.

Positively acknowledge the wait time

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. This only adds to the heightened anxiety patients are currently experiencing. And the volume of patients now waiting to be seen can mean wait times that extend for hours.   

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.

I used to say “I’m sorry for the wait,” or “Sorry for taking too long.” But now, I’ve learned to 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.

Karly Pippitt on learning on the fly

My experience after just a few weeks into virtual care has shown me how patients—old and young—are open and willing to receive care online. Visually seeing a new patient face to face helps establish a connection. For me, this experience has come with learning and flexibility as I try to get the same kind of communication that I do in person.

Be deliberate in opening the visit

I always introduce myself and ask how a person is at the beginning of the visit. Now I’m more deliberate about it. I ask—how are you? How are you doing with all of the things that are going on? How are you feeling? And then I listen. For patients that I’ve seen before, I ask about their work, their businesses, and how they’re doing balancing the stress.

Be yourself

Patients don’t expect you to be a robot. They expect and want you to be yourself, and that’s why they will continue to see you. Take advantage of your own communication skills. I’m more expressive with my hands, so I make a point to position the camera so my upper torso is showing. That way, patients can see gesture as I talk.

I teach first- and second-year medical students, and one of the most important things I instruct is to bring your own humanity and experiences to your practice. Draw on the authentic communication strengths you have to make it a better encounter. Are you ok with silence? How do you communicate emotion through expression? All are welcome—it's just important to know your own style and use it. We’re learning how impactful it is to practice using your own strengths through an innovative, interdisciplinary grant with the University of Utah Theater Department’s Dr. Sydney Cheek-O’Donnell, the chief of the School of Medicine’s Program in Medical Ethics and Humanities Dr. Gretchen Case, and the National Endowment of the Arts.

“Can you hear me now?” – tackling the technology

Technical challenges abound in this brave new world—crisis patient loads can result in wait times that extend for hours. Poor and dropped connections can render even the best platforms useless. But we still have to connect.

Here are some quick tips and direct links to resources available to help: 

Learn the platform

InTouch is the platform used by University of Utah Health for telehealth. Access the online training here

A growing list of COVID-19 Frequently Asked Questions is accessible here.

Before you begin basics

  • Ensure a HIPAA compliant environment. It is important to have a secure surrounding so that others nearby cannot hear the virtual visit. 

  • Speak at a comfortable volume that the patient can hear you but cannot be heard by others. Do not conduct the visit in a public space where other people will be or can potentially pass through.

  • Avoid distractions during visit (doorbells, phones, children, pets, etc.).

  • Dress appropriately (similar to coming to your health clinic in person).

  • Avoid sitting near or in front of a window or bright light.

  • To ensure that you have proper bandwidth for your virtual visit avoid using other devices that use network services like Netflix, Amazon Prime, Xbox, or other online resources.

  • Mute background noises like TVs & music.

Need help? Here’s who to contact

  • The Telemedicine support line is available 24/7 to answer your questions: 801-587-1922

  • For additional training, start with the Super User in your division. 

  • No Super User in your division? Contact the Outreach and Network Development Team (ONDT) operations support line 801-213-0794 (during standard business hours) or email: ONDToperations@hsc.utah.edu

Contributors

Jonathan Chao

PA-C, Redwood Health Center, U of U Redwood Urgent Care, University of Utah Health

Karly Pippitt

MD, Sugarhouse Health Center, University of Utah Health