Introduction to Telemedicine

Telemedicine is defined as the use of technology to deliver healthcare at a distance.  In your PCP, most of you will see synchronously delivered telemedicine visits. Your clinic may also use telemedicine asynchronously, allowing patients to share data like blood glucose logs or heart rhythm monitoring for review by their healthcare team, who then advise them on next steps with a secure message or phone call.

Specific patient consent is required for telemedicine.  Patients must agree to receive care on the virtual platform and to have their insurance billed. Clinic staff often complete this consent process before the provider begins their visit.

Key elements of this consent include:

  • You cannot provide the same evaluation as in a face-to-face visit, and an in-person visit may be requested by either the provider or the patient.
  • Technology is encrypted and secure, but no technology is 100% hack-proof.

Communications skills for telemedicine

As with in person visits, start by introducing yourself by name and role, ensuring comfort and privacy for your patient, and asking if they are comfortable conducting the visit where they are.  You can specifically ask if anyone else is in the room, and if the patient would like them to join the visit.

Ensure that you’ve optimized both your own technology and the patient’s before starting the history.  Each of you should be in a quiet and well-lit room, sitting away from windows and bright light sources to avoid shadows. Adjust your camera and ask the patient to adjust theirs so that you each see the other’s face. Hiding “self view” will allow you to focus on your patient.  Look directly at the webcam to convey “eye contact”. You can also let your patient know that at times, your eyes will move around as you may look at their chart as they talk.

From there, proceed with setting the agenda and building rapport.

In this video, Dr. Calvin Chou of the Academy of Communication in Healthcare demonstrates patient-centered communication in a video visit.

Physical exam in telemedicine

The physical exam will (obviously) be more limited in a telemedicine visit, but there are creative ways to maximize the utility of the exam.  In this video, a Stanford physician demonstrates problem focused-exams for upper respiratory infection, low back pain, and shoulder pain.

 

Resources and references:

The Telehealth 10: A Guide for a Patient-Assisted Virtual Physical Exam.

License

The Foundations of Clinical Medicine Copyright © by Karen McDonough. All Rights Reserved.