Improving Your Digital Bedside Manner

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Therapists and psychologists have learned a few things as pioneers in telemedicine. Here are some key tips from their research to help physicians across the healthcare landscape improve their digital patient encounters.

As with any innovation, there will always be the early adopters and the laggards. One of the first fields to embrace telemedicine has been behavioral and mental health. Mental health care is particularly well suited to telemedicine because of the cost benefits, its potential to improve access to specialist care and the relative ease of delivering care over a computer.

Being an early adopter has allowed tele-mental health to develop research and evidence-based practices that can be extrapolated to other fields that may be newer to telemedicine. Here are a few of the things they’ve learned over the years.
Providers should be constantly aware of how they present over a video link. The physical separation inherent to telemedicine can be bridged or widened based on the richness of audio and visuals, and on non-verbal cues such as vocal tone, quality, gesture, eye contact and facial expressions.
It is therefore important that providers be as comfortable and confident as possible when providing care via telemedicine technologies. A lack of comfort and confidence on the provider’s part can negatively impact and erode a patient’s trust, satisfaction levels and adherence to treatment recommendations. The literature on the use of telemedicine in psychiatry encourages clinicians to consider increasing their energy levels and expressiveness slightly to help overcome any feelings of distance or remoteness that might result from using videoconferencing.
Providers need to recognize that telemedicine is a two-way street, not a forum for the provider to talk while the patient passively listens. Allow time for psychosocial interactions and small talk as a part of the telemedicine encounter, such as allowing them to describe the reasons for the consultation or to express their concerns.
Both the patient and provider can make small adjustments to their environment to maximize the chances of a successful telemedicine session. For example, ensure there is adequate and natural lighting where possible, have a neutral and darker background and making sure all of one’s head and upper torso are in full view of the camera. The use of a headset containing a microphone has advantages such as cutting down background noise with an improved ability to hear more clearly. Headsets can minimize echo and can give patients an increased sense of privacy.
Consider the location of the video camera. Having it just above the screen of a laptop or desktop is optimal. Use of ‘picture-in-picture’ display allows the presenter to view how they’re being presented to the patient in real time. A word of warning however – clinicians should not be tempted to watch themselves in the little window while talking. Looking into the camera helps to give patient the impression that the provider is maintaining eye contact during the session.
The issue of depersonalization is frequently cited as a potential telemedicine drawback. However, the distance created by using telemedicine can be a source of clinical benefit in mental health. Patients can use telemedicine to avoid the potential stigma of having to visit a mental health facility in order to access services. Along similar lines, the distance and remoteness generated by telemedicine can create a sense of safety and depersonalization when discussing sensitive or stigmatized topics. Telemedicine puts control in the patient’s hands, even allowing patients the option of turning off the camera to speak with a degree of privacy.
Mental health has been a champion adopter of telemedicine. The available research and everyday experiences of those using telemedicine in delivering mental healthcare can offer insights and tips for other disciplines that perhaps haven’t fully realized the potential of this technology. Much of the advice is straight forward and easily implemented but it can have a tremendous impact on the telemedicine experience for both the provider and the patient.

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