Don’t tarnish your reputation with an amateur telemedicine performance: follow this code
Coronavirus has changed the playing field: telehealth is taking center stage in the care of patients. And that means we doctors need to brush up on our internet etiquette, known as netiquette.
With the recent relaxation of some restrictions for HIPAA and licensing, doctors are able to employ more virtual visits, and, for the first time, there are codes and reimbursements that make it possible to be compensated for telehealth.
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.
Netiquette tips for optimal virtual visits
Even though telemedicine visits are becoming popular, video conferencing netiquette can be a challenge to many doctors. I would like to offer a few suggestions for making virtual visits more professional.
Use a quality camera for telemedicine
This is not an unnecessary expense. Quality equipment makes communication with your patient effortless, and the quality of your visit will be significantly enhanced. The high quality of your image can even make patients feel more comfortable with the virtual visit. Netiquette implies the importance of using top-quality webcams to help your patient see you clearly while videoconferencing, without any distortion of your image or of your voice.
Use high-quality sound equipment
Another netiquette ground rule is to use only top-notch speakers and microphones for effective communication. Better equipment enhances the quality of the virtual visit and patient experience. It will serve as a surrogate for the quality of your practice.
Present a nondistracting background
I asked my daughter to review one of my virtual lectures on telemedicine, and she told me the background in my office, which includes lots of books and files, was very off-putting. If you are going to do telehealth consults in your office or from home, be aware of the background and make it as plain as possible. Or, place some potted plants behind or a clean wall with just your diplomas on it so it looks professional
Doctors often live the cliché of being late for office appointments. With a virtual visit, your patients are expecting you to be on time.
Check the lighting
Definitely minimize glare and reflections. Perform a test call to be sure you aren’t coming across with shadows cast over your face. Minimize any lighting or bulbs behind you that could be distracting to patients.
Minimize noise and visibility of others
You will want to ensure that the virtual visit is private and that there is no noise or commotion from your staff or family (or pets) in the frame. Turn off the ringer on your mobile phone, too, and silence any landline phones.
Neatness counts in videoconferencing
You’ll want to have a pristine desk with no files or papers other than any papers, charts or reports that are pertinent to the patient on the telehealth call.
Dress for success
We are trusted healthcare providers, and this means we have to dress like doctors, even when working from home. I wear a shirt, tie and a white lab coat. An alternative is to wear a scrub top with a lab coat. Make sure your hands are clean and nails are trimmed. Presenting yourself in a professional manner will make your patients more comfortable and confident with videoconferencing.
Netiquette means being on time, even for online doctor appointments
Doctors often live the cliché of being late for office appointments. However, with a virtual visit your patients are expecting you to be on time. Many patients are working remotely today and have other calls and meetings to attend. Some are helping their children with online school assignments. You don’t want to leave anyone staring at a blank screen, not knowing what’s going on.
One of the benefits of telemedicine for your patients is that it saves time otherwise spent in waiting rooms. Therefore, it is not acceptable for the doctor to keep them waiting at their computers.
Many telemedicine software programs have a notification system setup that will let the doctor know when a patient is available, as well as let the patient know when the doctor is ready. I suggest you consult with the vendor of your telemedicine program to be sure this feature is on your system.
Good netiquette is being prepared and paying attention
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 at charts or other papers on your desk.
Always maintain eye contact with the patients by looking straight into the webcam instead of their onscreen faces. One suggestion I heard about is to attach googly eyes by your webcam to simulate eye contact! It is acceptable to look down as you take notes to document the virtual visit, but don’t look down the whole time.
Also, listen carefully to hear what the patient has to say and nod to indicate that you are actively listening. Give your virtual visit your undivided attention. That means you cannot be tending to another activity on your computer, such as emails.
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, and announce when you anticipate that you will connect again with the patient. This avoids patients waiting by their computer until you return.
Netiquette requires follow-up and follow-through
As with any face-to-face visit, conclude by asking the patient if all of his or her 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\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 questions have been answered before terminating the visit. Make time to answer any final questions and clarify instructions before saying good-bye.
Finally, after answering all questions, be certain the patient understands your recommendations and knows about 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 documents for the patient, indicate if he or she wants to receive it via fax, email or postal service.
If there’s time, ask for feedback at the end of the virtual visit. This makes the patient feel that his or her input is important to your practice, and it will improve your next appointment.
Bottom line: Physicians can still demonstrate empathy and caring even if they can’t touch the patient. But following these suggestions will help you improve your connectivity using virtual healthcare and help maintain the doctor-patient relationship. If you have any ideas to enhance the virtual visit, please let me hear from you. Email me at [email protected].
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