Sharpen Your Telehealth Skills: 9 Tips for Doctors

In early April 2020, family physician Kyle Legott was recording a telehealth visit from his home in Aurora, Colorado. It switched to 100% virtual visits but was struggling with one thing.


Not the internet type, but the human kind. The kind that helps you gain a patient’s trust and can be difficult to configure through a computer screen.

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Today, Legault was meeting James and Sarah, a senior couple who are at risk of developing complications related to the coronavirus. Five minutes later, the doorbell rang, and the mail carrier left a parcel. Leggot shrank as his dogs began to bark and race to and from the door.

Leggot began to apologize, but James and Sarah’s face lit up. “Is that an Australian Shepherd?” they asked. The pup turned out to be their old dog Roy, who had been with them for 15 years but recently passed away.

That’s when James and Sarah opened up. Trapped in their mountain house, they had not interacted with anyone for weeks. They missed Roy so badly and seeing Legault’s dogs brought them joy in a time of anxiety and isolation. To this day, despite James’ death, Legott makes sure his dogs stand at his feet on every virtual visit with Sarah.

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The use of telehealth has declined since those early days of the pandemic, but the enthusiasm remains strong. According to a survey by the American Medical Association, the percentage of physicians using televised visits has grown from 14% in 2016 to 80% in 2022. Adoption is now so widespread that only “retarded” people are holding out.

“Patients and providers have had the opportunity to truly understand the value [virtual] said Stephen Schock, MD, a virtual health officer at the Cleveland Clinic.

it’s the truth. Telehealth offers convenience, cost-effectiveness, and a better work-life balance. However, technology has its limitations, and these limitations often affect our ability to communicate and make personal connections.

Why relationships with patients can be more difficult with virtual care

Research suggests that it can be difficult to listen intently and pick up on nonverbal cues, such as facial expressions and gestures, during video calls. Technical errors such as poor sound quality, crashes, or freezing do not help.

This is important because good patient relations are key to good care.

A Harvard review of more than a dozen randomized trials found that positive doctor-patient relationships can produce beneficial health effects as some treatments. Patients who feel connected to you may be more likely to share symptoms and trust the treatments you recommend. They may also be less likely to sue for misconduct.

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Connectivity builds trust, said Kent Northcote, MD, medical director in charge of the “web-side method” at telehealth provider MDLIVE. “If trust isn’t there, patients won’t care what you say.”

Legault noted that medical schools know this. “You learn and have a lot of classes about how to communicate with patients and how to form that relationship. But it’s all about personal matters because telehealth didn’t really exist.”

he is right. In 2019, less than half a percent of all ambulance visits in the United States were via telehealth, compared to 24 percent during the pandemic’s first few months. Perhaps that’s why 46% of clinicians in a 2019 study chose office visits over virtual visits to establish a “personal connection,” while less than 2% preferred the opposite.

Even if this situation has changed since then, almost establishing relationships with the patient remains a challenge, according to 2022 Telemedicine and eHealth Survey of Internal Medicine Physicians in New York. And in a prospective report from Elsevier Health, half of physicians agreed that “telehealth will negatively affect their ability to show empathy for their patients.”

Building patient relationships through telehealth

Fortunately, strengthening communication via telehealth Can Leggot’s story is proof of that. That’s why Leggott is now focusing on showing his dogs to patients. “If they’re a dog lover, it’s a mutual relationship,” he said. Even if they are not, it shows that “doctors are human too”.

“Sometimes my child would knock on the piano,” Northcott said. Many patients will comment, “My child plays the piano too!”

Isaac Dapkins, chief medical officer of the Centers for Family Health at NYU Langone, added that telehealth is a lens in your patients’ lives. “I can see what’s in the patient’s home. I can see what works and what doesn’t. I can see if there are children running or someone in the room. It gives context.”

Two of Dapkins’ patients — sisters with diabetes — use telehealth to get to him while they’re commuting, getting out of a taxi or walking. “I walk them into their lives,” Dapkins said. This provides insight he couldn’t get from inside the clinic.

Shook and Northcote, who train doctors to communicate better via telehealth, shared some tips. See if some of them might work for you.

See something, say something. plate spot? Sports equipment? faded? Ask about it. “It may sound unprofessional,” Shock admits, but it builds a relationship. When Chuck noticed golf balls, batons, and T-shirts during a television visit, he bonded with his patient because of their love of golf. This may have helped the patient share sensitive health information, Shock said.

Request an introduction. If someone else is in the room, asking the patient to introduce you may lead to helpful insights. Leggott likes to ask partners and family members for their ideas, and sometimes learns valuable information that the patient may not have originated.

smile more. When you smile, your patients will smile, thanks to what’s known as facial mimicry, which is your brain’s tendency to mirror the emotions it detects on another person’s face. Smiles help form bonds, and may improve a person’s ability to recover from stress.

Slower. In person, body language helps others follow what you’re saying, but in a virtual visit, they should rely more on your voice. “It’s not even the things you say, but the speed and cadence with which you say them,” Northcott said. “If you speak too fast, [patients] I can not hear you. Try this: Say ‘Nine cute night nurses suckle gently’ out loud four times, slowly enough to make the words clear. This is how fast you should be speaking during a virtual visit.

Read this book. Northcott suggests every doctor should read Never split the difference by former FBI negotiator Chris Foss. The doctors said negotiators. Negotiating is harder without body language, so what you say and how you say it becomes even more important.

Invite patients to say no. One tip from Voss book Northcote loves: Ask questions that make your patient say no. For example, instead of asking “Does this treatment plan look good?” Try, “Would you mind trying this treatment plan?” The word “yes” can feel like you’re committing. Saying no makes people feel comfortable, which means your patient may be more willing to share and share your concerns. Another example: instead of “Is that all?” Try “Is there anything else?” The first option prompts a “yes” – which can make the patient feel as if they cannot reverse course and add or clarify concerns.

Show that you are paying attention. In a small study in Journal of General Internal Medicine Patients reported feeling that physicians paid less attention to them in video telehealth visits than in in-person visits. Exaggerated gestures such as gestures to show you’re listening, suggest guidance from the Cleveland Clinic’s Center of Excellence in Healthcare Communications. Or steal another tip from Voss and repeat the patient’s last three words. (Patient: “I am not feeling well.” You: “I am not feeling well?”) This helps the patient feel that they are being heard and gives them an opportunity to clarify.

Rely on the language of the eyes. It may sound unnatural, but if you want to make direct eye contact, look at the camera, not the screen, as directed. If you’re really trying to communicate or speak with impact, look into the lens of your webcam. Try sticking googly eyes next to the lens to help you remember where to look.

Use a headset with a microphone. Your computer’s built-in microphone probably isn’t very good – many pick up a lot of background noise. Northcott, who uses a Sennheiser headset, said using a headset ensures your words are clear and can make the experience more intimate.

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