Methods for promoting a strong physician-patient relationship during telehealth visits include orienting and engaging the patient.
The dramatic growth of telemedicine during the coronavirus disease 2019 (COVID-19) pandemic is having a significant impact on the physician-patient relationship.
In March, when the pandemic took hold in the United States, telehealth visits increased 50%, according to Frost and Sullivan. With in-person medical visits associated with the risk of coronavirus infection, virtual visits emerged as a safe and effective way for patients to meet with their doctors in many circumstances.
"Whether telemedicine is a good or bad thing for the physician-patient relationship is largely dependent on the individual level of comfort of the patient and their physician," says Joy L. Lee, PhD, a research scientist at Regenstrief Institute and an assistant professor at Indiana University School of Medicine in Indianapolis.
During the pandemic, Lee says there are four primary ways to foster a positive impact on the physician-patient relationship while conducting a virtual visit.
1. Preparing the patient: Physicians should set expectations when starting a virtual visit with a patient, she says. When holding a patient's first virtual visit, the physician should say, "This is going to look different than our usual visits." Physicians also need to help patients realize that they are still getting healthcare during a virtual visit—they are still getting what they came for.
2. Engaging the patient: "It is important to prime patients with questions such as, 'What are some of the things you want to talk about today? What are your primary healthcare concerns?' Patients need to know that even though they are not in a clinic, their questions will still get answered," Lee says.
3. Organizational guidelines: "Institutions can help clinicians establish good relationships with patients as well. Physicians are feeling overwhelmed with a lot of things as they adjust their practices to the pandemic. So, it helps for hospitals and clinics to set best practices and guidelines for telehealth visits. For example, if you do not have a medical assistant who is doing the virtual rooming, institutions can provide guidance for physicians about questions they can ask to orient the patient," she says.
4. Acknowledge the pandemic's impact: "Physicians should make room to address COVID-19 even if a virtual visit is routine and has nothing to do with the coronavirus. Providers should ask a question or two such as, 'How are you doing now? How are you dealing with COVID-19? What does this pandemic mean for you?' It is helpful to acknowledge the pandemic because we are doing virtual visits in part due to the coronavirus. Providers should not skirt the issue," Lee says.
A more general best practice for physicians conducting virtual visits is to deliver the visit in a quiet and secure space, she says.
"Physicians should be in a quiet place because they are talking about personal health information. Physicians should make sure the patient is not hearing a lot of noise in the background, so they know the physician is in a safe environment. Physicians should not be interrupted during virtual visits—the patient should feel they have the physician's attention."
Another general guideline is to anticipate technical difficulties, Lee says. "Physicians should make sure they have the bandwidth for a video visit. They should have backups in place in case something goes wrong such as having a phone number for the patient to call if the video visit crashes."
Maintaining and building relationships through telemedicine
If a patient already had a great relationship with a provider before the pandemic, then the switch to video or phone calls will be relatively easy because there is already a maintained relationship, Lee says.
Establishing a good relationship through telemedicine is more difficult with new patients and patients who have had infrequent visits with a physician. For those patients, it takes time and effort to foster a strong relationship with patients through telehealth visits, she says.
"The practice needs to be proactive in communicating with patients. They can provide numbers to call, or let patients know that secure messaging is always available. Even for patients who have not seen their doctor in three years, they can be told proactively that they can schedule a visit if something comes up. Practices can let patients know how to schedule a virtual visit and let them know what a virtual visit will look like, so they know how to prepare for it."
Phone calls are an effective way to conduct this outreach, Lee says.
Reimbursement is the main area where the shift to virtual visits is having a business impact on physicians, she says.
"The amount of reimbursement and the types of services that can be reimbursed have changed during the COVID-19 crisis. Due to great lobbying by physician societies and other organizations, the Centers for Medicare & Medicaid Services has been flexible and reacted quickly to the pandemic. Now, phone visits can be reimbursed at the same rate as an in-person visit, and video visits can be reimbursed as well."
Reimbursement has changed in the short-term during the pandemic, and there will likely be lasting changes, Lee says. "Many of these changes are probably here to stay. We are seeing that the demand for telehealth is strong."
Recognizing telemedicine limits
With telehealth, it is important to remember the patients for whom virtual visits do not work, particularly video visits, she says.
"There are a lot of people in rural or low-income communities without stable Internet access. So, it is important for healthcare organizations to figure out how to reach those patients. It can be creating safe environments for face-to-face visits, or telephone calls, or giving patients resources so video visits are available for them."
Christopher Cheney is the senior clinical care editor at HealthLeaders.
To establish relationships with new patients or patients who have a history of infrequent visits, physician practices should have a proactive communication strategy.
From a business perspective, the major impact of virtual visits has been on reimbursement.
Physician practices should have a telemedicine strategy that accounts for patients who do not have adequate Internet access for video visits such as providing services via phone calls.