By Andrew Barbash, M.D.
Is the emergence of doctor consultations via video chat further evidence of the depersonalization of medicine, as some would argue? As a mainstream care model, telemedicine provides a combination of quality and convenience, is widely available, and often reimbursed. However, telemedicine continues to be plagued by an image problem founded on myths and untruths.
All medicine and healing —whether the physician is physically in the room or on video— is based on one fundamental principle: trust. Patients want a doctor who understands their health history, is knowledgeable and is going to make them better. This dynamic becomes ever more critical in an acute setting where health concerns are generally escalated and sometimes life or death. And while in-hospital telemedicine has become a widely accepted method of providing access to specialty doctors, several myths continue to perpetuate telemedicine’s perceived lack of personal connection. Let us break down the most common of these myths.
On-Screen Doctor is Disconnected from In-Room Staff
Many times, the physician on the screen is not a familiar local staff member. They may not even be local at all. So how can they be engaged and connected with onsite medical providers to offer adequate care remotely? The answer is simple: communication and carefully managed workflows. Today, over half of all U.S. hospitals use telemedicine. In each one of these, before telemedicine is implemented, the medical staff is expertly trained in the mechanics of clinical collaboration, working with on-screen physicians as a cohesive unit for the betterment of the patient.
The Screen is Ineffective for Patient Connections
There is a lot to be said about phoning-in a friend. In telemedicine, in particular, this could mean the remote physician is communicating with the hospital patient (and staff) on one screen, while at the same time conferring with a colleague on another screen – and perhaps bringing an out-of-town family member into the conversation on a third screen. The use of technology allows for instant connection for immediate decisions.
Telemedicine is Cold and Impersonal
On-screen physicians must work quickly to provide competent care while maintaining a rapport with the patient and, in many cases, the patient’s family. Digital bedside manner is the key to creating warm, personal connections. It’s about building a patient-doctor relationship of communication and trust, which requires more than just medical skill. Physicians create positive experiences through clear communication – asking questions, getting history, reviewing data and working through decisions together, as well as understanding the patient’s needs and providing empathy. It’s not about technology; it’s about care…like any other doctor-patient interaction.
Information is Lost in Translation
Telemedicine can be a superior model of care, not a substitution. As such, as with any method of care, coordination and planning are necessary for optimal outcomes. For example, a remote consult may be the most immediate way to get a patient in front of a specialist, but if the patient is incapacitated or, there’s a language barrier, the inability to communicate effectively is not a function of telemedicine but of planning. Whereas, if not a medical emergency, the consult could have waited until the evening when the family was present and able to ask and answer questions, and truly made it a constructive telemedicine engagement.
In a virtual environment, we must adapt personal interactions to the medium and telemedicine offers one of immediacy – instant connectivity and interactivity. When tele-providers focus on delivering the best connections possible, we can achieve truly personalized patient experiences with tailor-made results.
Andrew J. Barbash, M.D. is Chief of Neurology; Chair, Neurology Leadership Council – SOC Telemed
Dr. Barbash received his M.D. from Northwestern University Medical School in 1981 before completing his Neurology residency at Mayo Clinic in 1985. He is board-certified with the American Board of Psychiatry and Neurology and is a member of the American Academy of Neurology and the American Heart and Stroke Association. He is also a former co-chair of the MIEMSS (Maryland Institute for Emergency Medical Services Systems) Quality Improvement Committee for Stroke in Maryland. Dr. Barbash has overseen the deployment of the EMR at Kaiser Permanente in the Mid-Atlantic region as the VP of Clinical Information Systems and led the development of the Neurosciences and Stroke Program at Holy Cross Hospital in Maryland. In addition to his work as a full-time clinical teleNeurologist at SOC, he provides consulting in the field of virtual care as one of the founders of Apractis Solutions and a virtual clinic. With a passion for optimizing access to quality healthcare, Dr. Barbash has presented at numerous conferences around the U.S. and at several virtual international meetings on mobile health and collaboration, communication, and innovation in healthcare.