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Telemedicine calls for new etiquette guidelines

By Dr. Neil Baum bio

COVID-19 has changed the playing field and methodology of caring for patients. We no longer will be seeing all our patients in our offices. Also, there has been a relaxation of the restrictions, such as HIPAA, for using telemedicine and now, or the first time, there are codes and reimbursements that make it possible to be compensated for virtual care.

Just as there are proper behaviors expected of physicians who are face-to-face with patients, there is a new code of behavior for telemedicine.

Even though telemedicine appointments are becoming popular, video conferencing etiquette can be a challenge to many physicians. I would like to offer a few suggestions for making your telemedicine visits more professional.

Use good gear

Use the top-of-the line equipment. Even though it may seem an unnecessary expense, using only the best equipment will allow you to communicate with your patient effortlessly and the quality of your visit will be significantly enhanced. It is particularly important to use top-quality webcams to help your patient see you clearly without any distortion of your image or of your voice. Patients feel more comfortable with a clear view of their physicians during telemedicine visits. This also includes using only high-quality sound equipment (speakers and microphones) for effective communication. Better equipment enhances the quality of your virtual visit and will serve as the surrogate quality of your practice.

Have a non-distracting background. I did several virtual lectures on telemedicine and I asked my daughter to review the program and her comment was that the background in my office showing books and files was very oft-putting and viewers were looking at the titles of my books and not looking at the speaker. If you are going to do telemedicine consults in your office, be aware of the background and make it as plain and bland as possible. Better yet, place some potted plants behind you or at least have a plain wall without wallpaper prints or photos or all your diplomas on the wall. Check the lighting to minimize glare/reflections. Do a test call to be sure you aren’t too dark or that there aren’t any hot spots that are going to be distracting to the patients.

Keep it private

It is imperative that you ensure that the visit is private there is no noise from your staff if you are in your office or from family members if you are working from home. Also, have a pristine desk with no files or papers other than any papers or reports that are pertinent to the patient on the call. Another distraction to avoid is your mobile phone which should be turned off. This also includes silencing your landline phones.

Dress for success. We are healthcare providers, and this means we have to dress like a physician. I wear a shirt, tie, and a white lab coat. (I don’t put a stethoscope around my neck as I am a urologist and seldom use that instrument!) An alternative is to wear a scrub top with a white coat. The take-home message you want to be sure you convey professionalism and you can easily do that by looking like a doctor. Presenting yourself in a professional manner will make your patients more comfortable and confident in your role.

Be on time

Doctors have had the luxury of being late for office appointments. However, with a virtual visit, your patients are expecting you to be on time. Many of your patients are working remotely and have other calls and meetings to attend or your patients are helping their children with online school assignments, so it is imperative that you be on time for the telemedicine visit. One of the benefits of telemedicine for your patients is that a virtual visit saves patients the time otherwise spent in waiting rooms. Therefore, it is not acceptable for the doctor to keep them waiting at their computers. Many of the telemedicine programs have a notification system set up that will let the doctor know when a patient is available as well as let the patient know when the doctor is ready for the visit. I suggest you consult with the vendor of your telemedicine program to be sure this feature is on your system.

Just like in any other medical visit, ensure that you read your patient’s complaints and charts before the virtual appointment. Familiarizing yourself with your patient’s information will make the visit easier and more productive for both parties. This also allows you to look at the camera and not looking at charts or other papers on your desk.

Look at the cam

Always maintain eye contact with the patients by looking straight into the webcam instead of their onscreen faces. One suggestion I heard that I haven’t tried but would consider is to attach googly eyes by their webcam to simulate eye contact!  Also, listen carefully to hear what they have to say and nod to indicate that you are actively listening to the patient.

Give your visit your undivided attention. That means no emails or other forms of multitasking. Do not eat or drink coffee during the visit. Do not yawn or show any other signs of boredom. If you must excuse yourself from the visit, ask the patient for permission to leave, before logging off the call, announce when you anticipate that you will connect again with the patient. This avoids patients waiting by their computer until you return.

As with any face-to-face visit, conclude by asking the patient if all their questions have been answered. In the past, we referred to the situation as the “doorknob phenomenon” where the doctor believes the visit has concluded, closes the chart or the EMR, puts his or her hand on the door, and the patient says, “Wait, there’s one more question I would like to ask.” You can avoid that situation by making sure all their questions have been answered before terminating the visit. Make time to answer any final questions and clarify instructions before saying good-bye.

That final question

Finally, after answering all of their questions, be certain they understand your recommendations, know about their medications, and when to schedule the next virtual visit. Also, if appropriate and the patient needs to make an in-office visit, make the connection to the scheduling desk so the request and the patient don’t “fall through the cracks”. If there is a consent to sign, instructions to follow, prescriptions to fill, or educational for the patient, indicate if they want to receive it via FAX, email, or postal service (there’s that ‘ol oxymoron!).

Ask for feedback at the end of the virtual visit in order to improve your next appointment.

Bottom Line: At this time there are no golden rules that physicians can follow to make their virtual visits successful. However, you can demonstrate empathy and caring even if you can’t touch the patient. Perhaps a few of these suggestions will help you improve your connectivity using virtual healthcare. If you have any ideas to enhance the virtual visit, please let me hear from you. (













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