Incorporating telehealth into our practice has allowed us to continue to treat patients in the midst of this challenging pandemic. Looking toward the future, this option will make it possible to see patients who have busy schedules, live far away from the clinic, or have physical challenges that make travel difficult, encouraging patients to complete their course of treatment and preventing self-discharge.
Even with all the benefits of telehealth, however, virtual communication creates some new challenges, especially when it comes to establishing quality patient rapport. Keeping a few basics in mind will help you as you build relationships through telehealth.
Don’t forget—many of the interpersonal skills established throughout your career are still effective in the telehealth environment.
Establishing Rapport in a Virtual Environment
1. Maintain Good Eye Contact
Making and maintaining good eye contact in the virtual environment requires a bit more forethought than during face-to-face visits. You need to ensure that your webcam is set up so you can look at the camera the majority of the time.
Think of the camera as your patient’s eyes. It may be helpful to place the camera above the screen on which your patient appears. Also, if you have a two-monitor setup, be cautious about looking at the second monitor, because it appears as if you’re looking away from your patient. Nonverbal cues, like nodding your head, show that you’re listening if you have to look away.
Pay careful attention to your camera angle.2, 3 Can you see your nostrils? If so, your camera is too low. Think about the camera angles you see on television: The vast majority of the time, the camera is at or above eye level for a more pleasing angle that simulates face-to-face conversation.
Unfortunately, most laptop webcams are set too low. This can easily be remedied by raising the level of the laptop to eye level on a box or stand that raises/lowers. Add an external keyboard and mouse as needed to complete the setup.
2. Keep a Professional Appearance4,5
Don’t let a video visit be an excuse to wear your hoodie. You still need to look the part of a professional to help establish mutual respect with your patient.
3. Maximize Your Setup
Ensuring that your setup is sufficient comes down to two things—managing your home workspace and ensuring that your technology works well.
Check that you have good lighting in your workspace. Especially avoid light from behind or “backlighting,” which will make you appear to be in shadow. Conduct your telehealth appointments in a quiet room with ample space. Family members should never intrude on an e-visit. Even though you are at home, you should still follow privacy standards.
Establish and follow an onboarding process to help your patients ease into the telehealth experience. In many cases, this change is just as new for them as it is for you!
Check that your internet speed is sufficient. You can check your speed by Googling “Speed Test” and then choosing the Run Speed Test button. If the results come back with a slow connection speed, you may need to contact your internet provider to see what your options are.
Use a quality camera and microphone. Most smartphones and recent webcams released within the past two years should be sufficient.
Be prepared to provide basic troubleshooting for your patients for a virtual visit. Some of them may experience challenges as well, especially those who are less familiar with this type of technology.
4. Leverage Technology
Screen sharing is an excellent way to pull up an image or video of an exercise and show it to your patient. When you use video, you can pause at different points and explain what’s going on. You can also mute the audio if it’s distracting from verbal education. In many cases, the pre-recorded camera angles and video quality will be much better than what you can accomplish by simply demonstrating with only the webcam.
If your organization offers MedBridge’s Telehealth Virtual Visits platform, you can share and send home exercise programs right in the platform during the session and review them with your patient actively to solidify understanding. If you are not using the Virtual Visits platform, you can still send home exercise programs to your patient via email or app during the appointment and review them together to ensure your patient understands your instructions and can perform any exercises correctly.
5. Use Established Face-to-Face Communication Skills4, 5
Practice active listening. Listening translates well to telehealth; you just have to make sure you’re maximizing this skill. The importance of listening is best summarized by the late 19th-century physician William Osler: “Listen to the patient—he is telling you his diagnosis.”6
Establish shared goal setting and communicate likely outcomes to your patient. Express empathy.5 And don’t interrupt your patient. Telehealth sometimes creates a slight delay, which increases the likelihood of stepping on each other’s words. Anticipate delay and allow slightly more time between changing speakers.
It may take a little practice to get the hang of it, so it may be worth conducting video calls with friends and colleagues to assess each other’s camera angles and look for potential problems so you can address these ahead of your appointments.
Telehealth is here to stay. Mastering the use of it now and knowing how to establish and maintain good rapport via technology will help you better serve both your practice and your patients.
- Kairy, D., Tousignant, M., Leclerc, N., Côté, A.-M., & Levasseur, M. (2013). The patient’s perspective of in-home telerehabilitation physiotherapy services following total knee arthroplasty. International Journal of Environmental Research and Public Health,10(9), 3998–4011.
- Manning T. R., Goetz, E. T., & Street R. L. (2000). Signal delay effects on rapport in telepsychiatry. CyberPsychology & Behavior, 3(2), 119–127.
- Myers, K. & Cain, S. (2008). Practice parameter for telepsychiatry with children and adolescents. Journal of the American Academy of Child and Adolescent Psychiatry, 47(12), 1468–1483.
- Toh, N., Pawlovich, J., & and Grzybowski, S. (2016). Telehealth and patient-doctor relationships in rural and remote communities. Canadian Family Physician, 62(12), 961–963.
- Grzybowski, S. C. W., Stewart, M. A., & Weston, W. W. (1992). Nonverbal communication and the therapeutic relationship: leading to a better understanding of healing. Canadian Family Physician, 38, 1994–1998.
- Bliss, M. (1999). William Osler: A Life in Medicine. New York: Oxford University Press.