As elective procedures get pushed, checkups go digital and social distancing edges its way into nonurgent medicine, many clinicians in a variety of specialties now find themselves doctoring from afar. And when you've built a career caring for patients in person, that can be a difficult transition.
But in many cases, learning how to support patients when you can't be there with them is for the best. With vulnerable populations at increased risk of complications from COVID-19 — and healthcare workers on the frontlines of the pandemic — many private practices have undergone patient separation measures, reducing in-office visits to only the most necessary appointments.
The rise of digital care during COVID-19
Many visits are becoming phone-based or virtual as new rules from the Centers for Medicare & Medicaid Services relax telehealth requirements. Those rules provide, among other things, more ways to engage in telemedicine: For the time being, practitioners who engage in good-faith communications with patients won't have to worry about HIPAA penalties, even if they communicate via FaceTime or Skype. (You'll still need to check with your malpractice insurer to verify telehealth coverage, though.)
Multiple medical associations now recommend telemedicine as the viral spread intensifies, including the American Academy of Pediatrics and the American College of Physicians. Telehealth even has a role to play in the management of chronic diseases, with the American College of Cardiology recommending it for stable patients with heart disease.
How to support patients remotely
Even though it's the right thing to do, moving to a more socially distant relationship with patients can make it seem harder to practice medicine — or at the very least, do a proper workup.
It doesn't have to be. Doctors in the throes of COVID-19 protocols told the Philadelphia Inquirer that you can still get everything you need to evaluate patients via telehealth. It just takes some creativity.
For example, if you're in a video visit with a patient, check their environment for opportunities to uncover symptoms, just as you would in person. Ask them to move closer to a window where you can see them better or have them direct the flashlight from their phone toward their throat with an open mouth. And even if you can't use a stethoscope, you could ask them to hold their breath for as long as they can to help you deduce lung function.
Keeping the compassion in digital care
As you start to practice more medicine remotely, ensure that compassion doesn't get lost along the way. In a quick-start resource for enacting telemedicine, the American Medical Association offers tips that may help:
- Make it seamless: Develop a virtual visit protocol to plan for when telemedicine should be considered and who will do the visits. Add screener questions during scheduling to prioritize patient needs and get them what they need faster.
- Make it personal: Designate a quiet area to do virtual visits, and put your back against a wall. The setting should feel just as personal as a one-on-one visit; avoid having loud noises or people walking around in the background.
- Make it official: Treat the visit as you would any other office appointment, which means filing notes into the EHR, sending prescriptions and following up with additional information or answers to patient questions afterward.
- Make it easy: Since patient familiarity with technology can vary, think through how you'll help patients overcome barriers. Openly communicate that you're offering phone-based or virtual visits, provide instructions on how to use them and say why it's important that patients engage in those services.
Bottom line: Keep in mind that anxiety levels are high for everyone right now, including you, so practice patience and understanding. We're all in this together — not only as patients and providers, but as human beings most of all — so do what you can to be a calming, understanding and knowledgeable presence for everyone, including those who see you from afar.