How to Conduct a Professional Telemedicine Visit Using Good Webside Manner

Summary

Dr. Tanya Elliot shares her expertise on enhancing patient interactions through video consultations. She emphasizes the importance of setting up a professional background, dressing appropriately, and ensuring proper camera framing for effective eye contact. Dr. Elliot also discusses the nuances of communication, such as maintaining warm facial expressions and obtaining patient consent. She advises on clinical documentation during the encounter and the value of setting expectations for any multitasking. The video concludes with the significance of summarizing the visit and providing patients with written instructions to ensure clarity and confidence in their next steps.

Takeaways

• 👩‍⚕️ Dress professionally for video consultations, just as you would in an office setting, to maintain a professional appearance.
• 🏠 Choose a simple, non-distracting background for your video calls, avoiding doors directly behind you to prevent a sense of urgency to leave.
• 📹 Ensure your face is centered in the camera frame to maintain a professional and approachable demeanor.
• 👀 Practice making eye contact by looking at the camera lens, which can be counterintuitive but is essential for effective communication.
• 🗣️ Start the consultation by introducing yourself and asking for the patient's permission to proceed with the video visit.
• 😯 Be mindful that facial expressions are more pronounced on camera, so maintain a warm and friendly demeanor throughout the call.
• 👁️ Use the reflection of your face on the screen as a 'cheat sheet' to monitor your expressions and maintain good eye contact.
• 💻 If you need to type or look at another screen during the consultation, inform the patient to set expectations and reduce distractions.
• 🔍 During the physical examination part of the video visit, guide the patient through each step and explain what you are looking for.
• 📝 Summarize the consultation by providing a clear plan and next steps, and offer to send written instructions to the patient for reference.
• 💌 Follow up with the patient by sending a summary of the visit and any agreed-upon action items through their patient portal for clarity and retention.

Q & A

What is the importance of dressing professionally for video consultations as mentioned by Dr. Tanya Elliot?

Dr. Tanya Elliot emphasizes that dressing professionally for video consultations is crucial as it sets the stage for professionalism, just as it would in an in-person office visit. Wearing a white coat or maintaining the same professional attire as in the office helps establish trust and conveys a serious approach to the consultation.

Why should the background of a video consultation be considered?

The background of a video consultation should be considered because it contributes to the overall professionalism and comfort of the interaction. A plain white wall or a bookshelf can be used, but being directly in front of a door can make patients feel uneasy, as if the doctor wants to leave. Therefore, the background should be non-distracting and conducive to a professional setting.

How does Dr. Elliot suggest maintaining eye contact during video consultations?

Dr. Elliot suggests that to maintain eye contact during video consultations, one should look directly at the camera lens rather than at the video feed of the patient or themselves. This counterintuitive approach ensures that the patient perceives direct eye contact, which is essential for effective communication.

What is the significance of framing one's face correctly within the camera view during video consultations?

Framing one's face correctly within the camera view is significant because it ensures that the patient can clearly see the doctor's facial expressions, which are crucial for non-verbal communication. Being too close or too far, or being off-center, can lead to a less personal and professional interaction.

Why is it important to ask for the patient's permission at the start of a video consultation?

Asking for the patient's permission at the start of a video consultation is important because it sets the stage for mutual respect and understanding. It acknowledges that the video consultation is a new experience for both parties and establishes the encounter with the same level of professionalism as an in-person visit.

How can doctors leverage their own video feed during consultations for better communication?

Doctors can leverage their own video feed by occasionally glancing at it to ensure they are maintaining appropriate facial expressions and not making any unintentional 'funky' expressions that could distract or confuse the patient. This real-time feedback helps in honing communication skills.

What should doctors do if they need to type or look at multiple screens during a video consultation?

If doctors need to type or look at multiple screens during a video consultation, they should inform the patient beforehand. This transparency helps manage patient expectations and reduces the potential for distraction or misunderstanding, ensuring the patient feels included in the process.

Why is it beneficial to involve the patient in the physical examination process during a video consultation?

Involving the patient in the physical examination process during a video consultation is beneficial because it ensures the patient's active participation and understanding of the steps being taken. It also helps the doctor obtain the necessary information for an effective consultation by guiding the patient through each aspect of the examination.

How should doctors summarize and conclude a video consultation according to Dr. Elliot?

Dr. Elliot suggests that doctors should summarize the consultation by reviewing the patient's history and the findings from the physical examination. They should then discuss the diagnosis, next steps, and any recommended actions. This summary helps in shared decision-making and ensures the patient leaves the consultation with a clear understanding of what to do next.

What is the value of providing written instructions to patients after a video consultation?

Providing written instructions to patients after a video consultation is valuable because it reinforces the information discussed during the encounter. It helps patients remember the next steps and recommendations, which is particularly useful given that patients often remember only a small percentage of what is discussed during medical consultations.

Outlines

00:00

👩‍⚕️ Setting the Stage for Video Consultations

Dr. Tanya Elliot shares her expertise on conducting video consultations with patients, emphasizing the importance of setting up a professional environment. She suggests wearing a white coat or professional attire, choosing a neutral background like a white wall or a bookshelf, and avoiding sitting directly in front of a door to prevent patients from feeling rushed. Dr. Elliot also advises on proper camera positioning to ensure the doctor's face is centered and at an appropriate distance, and the necessity of doing a video test beforehand. She stresses the importance of making eye contact with the camera lens to establish a connection with the patient and the need for clear communication, including asking for the patient's consent before proceeding with the consultation.

05:02

💻 Enhancing Communication and Documentation in Video Consults

In the second paragraph, Dr. Elliot discusses the nuances of communication during video consultations, highlighting the need for clear and open dialogue. She advises on the importance of patient consent and setting expectations for the consultation. Dr. Elliot also addresses the challenges of clinical documentation during the encounter, suggesting that doctors inform patients if they will be typing notes to avoid distraction. She mentions the use of multiple screens or tabs for efficient consultation and the importance of keeping patients informed about any actions that might divert the doctor's attention. The paragraph concludes with a recap of the consultation process, including obtaining patient history, conducting a physical examination with patient involvement, and summarizing the visit with a shared decision-making approach. Dr. Elliot also recommends providing written instructions to patients via email after the consultation to ensure they understand and remember the discussed actions and next steps.

Keywords

💡Professionalism

Professionalism in the context of the video refers to maintaining a professional demeanor and appearance during video consultations. Dr. Tanya Elliot emphasizes the importance of dressing in a professional manner, similar to what one would wear in an in-person office setting, to convey a sense of authority and trustworthiness. This includes wearing a white coat if that's the usual practice in the office, or dressing in a professional attire like a shirt and tie. Professionalism is crucial as it sets the tone for the video consultation and helps establish a patient's confidence in the doctor's expertise.

💡Eye Contact

Eye contact is highlighted as a critical aspect of effective communication during video consultations. Dr. Elliot points out that looking directly into the camera lens simulates eye contact with the patient, even though it might feel counterintuitive. This technique is essential for creating a connection and ensuring that patients feel engaged and heard. The video script mentions that failing to make eye contact can lead to patients feeling that the doctor is disinterested or distracted, which can negatively impact the consultation.

💡Background

The background in a video consultation refers to the physical setting behind the doctor during the video call. Dr. Elliot recommends a neutral and professional background, such as a white wall or a bookshelf, to avoid distractions and maintain a professional appearance. She also advises against having a door directly behind the doctor, as it might subconsciously signal to the patient that the doctor is eager to end the consultation. A well-chosen background contributes to a comfortable and focused environment for the patient.

💡Facial Expressions

Facial expressions play a significant role in non-verbal communication during video consultations. Dr. Elliot notes that on camera, expressions are often more exaggerated than in person, which means that doctors need to be mindful of their facial cues. Warm and kind expressions can help convey empathy and understanding, while negative expressions like scowling could be misinterpreted and harm the patient's perception of the consultation. Being aware of one's facial expressions is crucial for maintaining a positive and effective interaction.

💡Clinical Documentation

Clinical documentation refers to the process of recording patient information and the details of the consultation. In the video, Dr. Elliot discusses the importance of informing patients if the doctor will be typing during the consultation. This transparency helps manage patient expectations and reduces the potential for distraction caused by the sounds of typing. Effective clinical documentation is essential for accurate patient care and follow-up, and it's a critical part of the video consultation process.

💡Multiple Windows

Multiple windows in the context of the video script refer to the use of multiple computer screens or open tabs during a video consultation. Dr. Elliot mentions that doctors might have to look away from the camera to refer to patient records or other resources. It's important to communicate this to the patient to avoid any confusion or discomfort. Managing multiple windows efficiently can enhance the consultation by allowing the doctor to access necessary information quickly, but it requires setting clear expectations with the patient.

💡Physical Examination

A physical examination in a video consultation involves guiding the patient through self-examinations or demonstrations that the doctor can observe through the camera. Dr. Elliot stresses the importance of explaining each step to the patient and setting expectations for what the doctor will be looking for. This collaborative approach ensures that the doctor can gather the necessary information for diagnosis while involving the patient in the process, which can lead to a more effective and satisfying consultation.

💡Shared Decision-Making

Shared decision-making is a process where both the doctor and the patient collaborate on determining the best course of action for treatment. In the video, Dr. Elliot discusses the importance of summarizing the consultation and involving the patient in the decision-making process. This approach empowers the patient and ensures that they understand and agree with the recommended plan of action. It's a key component of patient-centered care and is essential for building trust and ensuring patient compliance with treatment plans.

💡Patient Instructions

Patient instructions are detailed guidelines or recommendations provided to the patient after the consultation. Dr. Elliot mentions writing down everything discussed during the video visit and sending it to the patient through their patient portal. These instructions serve as a reference for the patient, helping them remember the next steps and any actions they need to take. Providing clear patient instructions is a valuable way to support patient understanding and adherence to the agreed-upon treatment plan.

💡Telemedicine

Telemedicine refers to the use of technology to deliver healthcare services remotely. Throughout the video script, Dr. Elliot discusses various aspects of conducting effective telemedicine consultations, such as setting up the video environment, communication skills, and managing patient expectations. Telemedicine is the overarching theme of the video, as it explores how to adapt traditional medical consultations to a virtual format, ensuring that patients receive quality care even when they are not physically present in the doctor's office.

Highlights

Dr. Tanya Elliot shares her experience with over 7,000 patients through video visits.

Key aspects of exceptional website manner in video consultations are discussed.

Wearing a white coat or professional attire can maintain professionalism in video encounters.

Background setup recommendations include a white wall or bookshelf, avoiding direct placement in front of a door.

Proper framing of the face within the camera view is crucial for effective communication.

Eye contact in video consultations is achieved by looking at the camera lens.

Initiating the consultation with eye contact and warm facial expressions sets a positive tone.

Asking for patient consent before starting a video consultation is important for setting expectations.

Facial expressions and body language are more exaggerated on camera and should be mindfully managed.

Using a 'cheat sheet' like one's reflection in the video window can help monitor expressions.

Clinical documentation during the encounter should be communicated to the patient to avoid distractions.

Having multiple windows or screens can be useful but requires informing the patient to maintain transparency.

Physical examination in video consultations requires patient participation and clear instructions.

Summarizing the consultation and providing next steps helps in shared decision-making.

Providing written patient instructions after the visit aids in reinforcing the consultation's key points.

Dr. Elliot emphasizes the importance of setting expectations and maintaining a professional approach in video consultations.

Transcripts

hi I'm dr. Tanya Elliot as some of you

may know I've seen over 7,000 patients

through video visits and so I'd like to

think that I've started to nail down the

key aspects of having exceptional

website manner when I interact with

patients so this takes some practice and

getting used to and I've taken a lot of

patient feedback in and trained a lot of

doctors on how to have exceptional

communication skills through this

modality of video consultation now it's

different from what we're taught in

medical school when we have standardized

patient examinations and you're doing

this in the office it's just a bit of a

different setup so first things first in

terms of setting up an appropriate

background and setting the stage for

professionalism I recommend if you wear

your white coat in the office which I

often don't but if you do wear your

white coat in the office feel free to go

ahead and wear your white coat for the

video encounter however you dress

whatever your professional dress is for

the office whether you wear a dress a

shirt and tie

if you wear scrubs do the same thing for

the video consultation in terms of a

background you can have a white wall

that's perfectly fine it might be a

little bit bleak so you may want to put

a painting up behind that or perhaps a

bookshelf that's perfectly fine as well

one thing you don't want to do is be

directly in front of a door studies have

shown that when patients see is a door

directly behind the practitioner they

feel sensation that the patient that the

doctor wants to turn around and leave

right away and so you want to avoid

being directly behind a door it's okay

to have a doorway away in your

background like I do but you don't want

to be directly in front of a door also

making sure that your face is perfectly

framed up within the middle of the

camera you don't want to be like this

talking to the patient you don't want to

be like this talking to the patient you

don't want to be over here you don't

want to be over here so making sure that

you're the appropriate distance right

now I'm a proxy

only two feet away from the camera so

again making sure your face is framed

and doing a video test beforehand so

that the patient doesn't have to wait

while you properly position the camera

the next aspect is eye contact and this

can be really challenging because when

you're talking with a patient through

video you want to be looking directly at

the patient so right now I'm looking

quote directly at the patient I'm

looking directly at myself however I'm

not making eye contact with them I was

not making eye contact with them I

actually have to look directly at the

lens of the camera in order to make eye

contact with the patient so it's a

little bit counterintuitive our eyes

often shift to either look at ourselves

or to look at the patient directly but

the patient isn't perceiving that you're

looking at them directly so make sure

that your eyes are parallel to the lens

of the camera that's how you make eye

contact through a video visit and it

makes a big difference your eyes your

facial expressions all of those things

are more exaggerated when you're on film

when you're on camera so just make sure

that you have nice warm kind eyes if

you're looking directly at them and buy

directly at them I mean looking directly

at your camera and initiating the

consultation that way another thing that

helps set the stage for a video

consultation is to ask their permission

to ask their consent so if it's a new

patient you introduce yourself hi I'm

dr. Elliot it's nice to meet you

and then the next section is do I have

your permission to treat you through

this video consultation setting that up

is tremendously important because both

for the doctor and the patient

this entire encounter is new and so you

want to make sure that you frame it up

with the same level of respect and

professionalism that a patient

experiences when they walk into your

office okay so we've checked off

background dress and professionalism how

to frame up the camera and then we

started to talk a little bit about

communication skills so making eye

contact with the camera again

tremendously important and then making

sure you're keeping your facial

expressions in

remember everything is exaggerated on

camera so you may be scowling you may be

making a certain face you may be looking

away and all those things are

exaggerated when you're on video so just

keep that in mind now often times when

you're doing a zoom or FaceTime or any

video modality you actually have a

little cheat sheet so you might not have

been aware of and that's your face in

the upper or lower right or left hand

corner so every now and then while

you're doing the encounter glance over

at your face just give it a bit of a

reality check make sure you're not

making any funky facial expressions and

leverage the fact that you can see

yourself and get real-time feedback

during the encounter it's tremendously

helpful as you continue to hone your

website manner skills the next thing

that's very important is your clinical

documentation and at what point you do

that during the encounter if you decide

that you want to do documentation while

you're interacting with a patient that's

perfectly fine but let them know that

you're going to be typing while you're

interacting with them so I'll often say

to the patient you may hear me typing

right now and that's because I want to

make sure I get down every detail of

what you're explaining to me the reason

that's important is the patient can hear

you typing so if you're going and

clicking while the patient is talking

and you're clicking and clacking on your

computer it could be very distracting to

the patient but if you let them know up

front and you set those expectations up

front it oftentimes is perfectly fine or

the patient may say oh I prefer that you

don't because it's distracting to me

which is okay as well but again setting

those expectations up front is very

important now the other piece is having

multiple windows open so some doctors

will have two computer screens up and

they're looking back and forth between

the two screens and some doctors have

multiple tabs up so they can be typing

and talking with the patient and then

looking away because they're looking at

another tab on their computer screen

again it's perfectly fine to do that and

to look away and even look up something

while you're on the consult with the

patient as long as you let them know so

I will let my patients know just want to

make you aware that I have

two computer screens up right now so if

you see my eyes darting away it's

because I have your patient record on

one side and that's what I'm looking at

when you see my eyes move over here and

then of course I want to make sure that

I make eye contact with you so letting

your patients know that or letting them

know that perhaps you're looking up the

most recent guidelines all of those

things are completely appropriate well

received by patients you just want to

let them know that you're doing that up

front

again all these nuance things that are

slightly different through video so you

want to just go through this journey

together with the patient and set those

expectations up front now I've talked a

lot about physical examination and how

to frame up the visit and so just to do

a bit of a recap you want to set up the

conversation obtain consent from the

patient ask open-ended questions to have

them tell you about what's going on and

the history of present illness and if

there are new patient past medical

history medications allergies oftentimes

video encounters will be much more

consolidated than in an office visit

because they're very efficient you're

making direct eye contact with the

patient and both of you are getting to

the point so you get that history of

present illness and then you do the

appropriate aspects of a physical

examination and in order to be effective

at that your patient has to be a partner

with you on that journey talk them

through each aspects of a physical exam

if you're going to be evaluating the

sinuses let them know up front we're

going to do the sinus evaluation now

here's what I need you to do then we're

gonna move on to the respiratory exam

here's what I need you to do and setting

those expectations along the way enables

you to get the objective information

that you need in order to conduct a

successful visit the last piece of a

video visit is to sum up everything that

has occurred so patient based on your

history of what you told me as well as

the aspects of the physical exam here's

what I think is going on and with the

telemedicine visit we may not be able to

make the complete diagnosis we may have

next steps that are recommended whether

it's to get a lab tests or

it's a higher level of care or higher

level of acuity and all that's perfectly

fine but after you go through this

journey with the patient getting that

intake getting those objective measures

of the physical examination now it's

time for the shared decision-making and

making that plan and conveying that

information to the patient the last

thing I do for my patients is I write

down everything that I've discussed in

the form of patient instructions that

they then email over to them through

their patient portal and patients find

this very valuable because all of this

is new for them and they're struggling

to remember everything you say and we

know that patients typically only

remember about 10 percent of what we

tell them in the office so let them know

that you're going to be writing up

instructions for them that have reviewed

next steps and all the things that you

have discussed during the encounter so

that they feel confident that they know

what to do next

that's all for now thanks for watching