Clinical Corner: Virtual Practices in the Age of Telemedicine

By Leah Meuter

As we are all aware, the COVID-19 pandemic has resulted in a massive cultural shift in medicine to deliver virtual care —an impact that is predicted to outlive the virus itself.¹ While the rapid implementation of telehealth led to many published views on policy changes, insurance coverage, and barriers to patient access, there seemed to be little to no literature on how providers could effectively enhance the provider-patient relationship over a virtual platform.

Together with the guidance of my p rincipal i nvestigator, Dr. Karel Pacak (a practicing physician), and Katherine Wolf (current medical student), we created a commentary article that discusses telemedicine with both provider and patient considerations.² Please see Table 1 of the publication for a general overview.

We cover three topics in this article that we termed “virtual-clinical values.” Here are the basics:

Ⅰ. Appearance

Research in traditional settings suggests that appropriate attire can establish patients’ trust and increase their willingness to share their medical concerns with their providers.³ Clinicians should maintain business professional attire under a white coat. Clothing with large patterns or logos should be avoided, as well as excessive jewelry or accessories, as these items can cause both visual and audio disturbances.

Ⅱ. Communication

Current research suggests that a provider-patient relationship can be established over telemedicine if strong communication skills are used.⁴ We discuss verbal techniques (patient-centered questioning and shared decision making) as well as non-verbal techniques (head-nodding, upright posture, and appropriate facial expressions) that should be practiced regularly during a virtual visit. Providers should note that eye contact, a vital non-verbal communication tool, is established by looking into the camera on their device or desktop, instead of looking at the patient’s eyes on the screen.

Ⅲ. Environment

Providers should strive to give virtual care from a neutral, uncluttered space to reduce distractions. Providers should be cognizant of patient privacy concerns and encourage the use of headphones or chat features if needed.

Throughout this article, we consider how health care professionals can continue to build trusting and meaningful professional relationships with their patients, even over a telemedicine platform. As our nation adapts to the seemingly new normal of virtual medical care, we must ensure that maintaining professionalism and patient respect is at the forefront of our efforts.

References

1. “COVID-19 makes telemedicine mainstream. Will it stay that way?” American Medical Association . Accessed June 1, 2020, at https://www.ama-assn.org/practice-management/digital/covid-19-makes-telemedicine-mainstream-will-it-stay-way.
2. Meuter L, Wolf K, Pacak K. (2021). “Maintaining professional encounters and enhancing telemedicine interactions with core virtual-clinical values.” Endocr Pract. 27(1):77–79. doi: 10.1016/j.eprac.2020.11.006.
3. Rehman SU, Nietert PJ, Cope DW, Osborne Kilpatrick A. (2005). “What to wear today? Effect of doctor’s attire on the trust and confidence of patients.” Am J Med. 118(11):1279–1286.
4. Elliott T, Tong I, Sheridan A, Lown BA. (2020) “Beyond convenience: patients’ perceptions of physician interactional skills and compassion via telemedicine.” Mayo Clin Proc Innov Qual Outcomes. 4(3):305– 314.