ll of our practices scaled up virtual care almost overnight – an amazing feat that has allowed us to care for our patients during a worldwide pandemic. It happened so quickly many of us didn’t have time to slow down and be deliberate about our communication practices. Here are three competencies to carry with you into the next year of virtual care.
1. Communication is quality
Digital communication includes speech, body language, presentation and how you include and inform the patient in their care.
Speech. Speaking slowly is so important in a virtual visit. There is often a delay in web visits, so I try to speak more slowly than I’m used to.
Body language. Moving slowly is also important. Make sure your gestures are made in view of the camera. I also explain to patients what I’m doing. I have my computer screen positioned so that I can type and look at them at the same time, but I always call out what I’m doing. I tell patients, "If it's okay with you, I'm going to make some notes. I'm going to be looking at your chart while you talk, is that all right?" And I frequently look back at them so they know I’m listening. I say “I don't want to miss anything that you're saying, so I'm going be taking some notes while we talk."
Presentation. What you and your environment looks like also communicates trust and professionalism. Many patients still dress up to go to the doctor’s office, so I try to treat a virtual visit just like an in-person visit. I dress as I do in clinic when I’m seeing patients virtually. I wear scrubs, I put on my badge. Solid colored clothing works better than patterns and usually looks better against a neutral background.
Include and inform. I share the patient’s record with the patient, just like I would in an in-person visit. Patients want to see their chart, they want to know what you’re writing isn’t a secret. I share my screen with the patient, but I make sure to stop sharing and I’m mindful of others’ PHI. If you’re unsure how to do it, try practicing with a colleague so that you can be familiar with the technology platform from both the patient and clinician perspective.
Lastly, while you may want to blame the technology or commiserate with the patient if the platform isn’t cooperating, don’t. It’s a bit like saying your enemy is my enemy, so we’re on the same side, against the technology. But the technology platforms are actually part of your practice and the U of U Health brand. By talking down about the technology, you’re actually reducing trust in your practice. Instead of saying, "Oh, isn't it frustrating? Aren't you just so sick of it?" I say, "Hey, thanks for being patient. I'm sorry if it was frustrating for you," or “Way to stick with it. Good job. We did it."
2. Maximizing the virtual interaction
Digital interaction presents new opportunities and challenges in assessment, disclosure and preparation.
Assessment. When clinicians consider the virtual clinical interaction, they sometimes think "What can I do clinically through a virtual medium? I can’t do a physical assessment." I actually do an environmental assessment, which I normally can't do. I learn so much about my patients, seeing them in their natural habitat. I can ask to see their medicine cabinet. I say “Let's go take a walk to your medicine cabinet. Why don't you show me what's in there?" I’m always trying to figure out what people are taking. One of my patients showed me her medicine cabinet, and I said, "Oh my gosh. Okay. I want you to put all that in a bag, and I want to see you in person with all that stuff."
Disclosure. It’s also important to ask the patient if they are comfortable disclosing private information where they are. If someone is in the room with the patient, I make sure they understand that by having that person there, the patient is giving me permission to talk about their care with that person. People don’t always remember that the person in the room may hear sensitive information. I’ll sometimes ask, "Do you want go somewhere where it's more private before we talk about your depression?"
Preparation. Patients aren’t usually well prepared for their virtual appointment. I make sure I’m prepared for their unpreparedness. Patients don’t have the usual rituals before their appointments—waiting in the lobby, waiting in the exam room. I always review notes, as well as the notes the patient includes when they schedule the appointment. I also ask "Is there any other questions that you have for me today? Is there anything else I can help you with?" It can be like Pandora's Box, but I find that patients usually have something else to say.
Sometimes I'll say, "It said in the notes that you wanted to talk about your mammogram." And they completely forgot why they even made the appointment. Happens all the time. I remind them what they typed, that's why I like the patient-scheduled appointments as well. The patients put in there exactly why they're being seen.
3. Legal and billing standards
Originally, we were granted many exceptions regarding billing, compliance and licensing during this crisis. Some of these exceptions have already been retired, and the rest will likely be retired. Luckily, we have a team to help us. Utah's Outreach and Network Development team helps us stay in compliance as the rules have shifted.