Techniques for a Successful Telemedicine Visit

Published on: December 8, 2020

As the use of telehealth has continued to explode in the U.S., physicians are increasingly learning how to navigate a new way of interacting with patients and delivering medical care using real-time videoconferencing.  With experience comes an appreciation of the benefits, and the problems, associated with practicing medicine through a remote connection. 

Distractions are a major problem during telemedicine visits, both for patients and physicians.  A recent study of over 1,000 individuals revealed that 73% of men and 39% of women report multitasking during telehealth visits.  Some of the distractions included: 

• Surfing online/emailing/texting (24.5%) 
• Watching TV (24%) 
• Eating (21%)
• Playing a video game (19%) 
• Smoking (11%) 
• Driving (10%) 
• Drinking alcohol (9.4%)
  

While their “extracurricular” activities during telemedicine sessions are necessarily more limited than what is listed above, even physicians report having to resist the temptation to check email or research online information during virtual visits. 

There are various techniques physicians can employ to set up the physical space, minimize distractions, address technology issues, and maximize the overall effectiveness of telemedicine visits.  A few of these are listed below. 

Physical Space- Patient 

• Confirm that the patient is in a safe, secure location to receive medical care. 
• Confirm that the patient’s location is logistically appropriate for the visit; that it is well-lit, relatively quiet, and free of distractions. 
• Verify whether anyone else is present with the patient. 
• Confirm the patient’s physical location (such as their address) for safety reasons and to verify compliance with state licensure requirements. 
• Consider asking the patient whether they are recording the treatment session (see below for physician recording). 
• Depending on the type of care being provided, discuss with the patient what will occur in the event of a medical emergency. 

Physical Space- Physician 

• Conduct telemedicine sessions in a private, quiet area free of distractions. 
• Consider conducting sessions in an examination room or personal office, rather than a busy space such as a hallway or front office area. 
• Dress professionally; consider wearing a lab coat and/or name tag so that patients clearly understand that they are interacting with a physician. 
• Place your camera at eye level to maximize eye contact with patients (avoid placing the camera below your face). 
• Adjust lighting appropriately; avoid having windows behind you and try using overhead lighting or a ring light. 

Minimize Distractions 

• Avoid multitasking, and give patients your undivided attention during telemedicine visits; if you need to do something else, let patients know what you are doing so they know they are your only priority.  
• Instruct office staff not to interrupt you during telemedicine sessions. 
• Consider placing your phone in a desk drawer or outside your reach so it doesn’t distract you. 
• Shut down other devices and/or close programs (email, social media) that might create distractions during sessions. 
• Resist the urge to look up information during sessions, even if it is relevant to the patient. 
• Instruct patients to avoid distracting activities during telemedicine sessions, and consider requiring patients remove technological distractions during visits. 
• Show empathy through carefully-chosen statements and nonverbal communication to show that you are listening to the patient and understanding their concerns. 

Technology Issues 

• Invest in a high-quality webcam and microphone for better video and audio quality, and consider using headphones or a headset. 
• Maximize bandwidth by using a wired internet connection, shutting down other programs, and plugging your device/computer into a power source.  Test your internet speed at www.fast.com.  
• Know the contact information for your video platform’s technical support service.   
• Verify that the patient is using a secured internet connection (as opposed to public wifi). 
• Ensure that patients know the process for reconnecting in the event of a temporarily lost or dropped connection. 
• Provide patients with an alternate means of communication (like a phone number or email address) in the event of a connection failure, like a power loss or technical problem. 
• Consider having an early log-in process, and using a staff member greet patients and assist with any technical issues. 
• Determine whether you will be recording sessions; if so, clearly communicate this to patients before each visit. 

Documentation 

• Document each visit thoroughly and accurately in the medical record as if it were an in-person visit. 
• Document the patient’s agreement to each telemedicine visit. 
• To the extent that a telemedicine visit is being conducted in place of an in-person visit due solely to patient access issues, COVID-19 mitigation, or patient insistence on virtual care, document this as a reason for proceeding with the telemedicine visit.  

Patient Preparation 

• Ask patients to gather their medical history and any medications prior to the visit, and to come prepared with issues and questions to discuss. 
• Ask patients to wear loose-fitting clothing, if appropriate, so they can be prepared for a partial physical exam. 
• Consider advising patients what to expect during a virtual visit, such as any information they will be asked to provide or if they will be asked to participate in any testing or a virtual physical examination. 
• Encourage patients to take notes during the virtual visit. 
• Instruct patients as to next steps following the virtual visit.