Telemedicine: Virtual Connection in an Age of Social Distancing

We in health care are looking forward into an ill-defined and rapidly changing landscape filled with uncertainty, danger, and quite a lot of human anxiety. And yet, as a palliative care physician, I feel remarkably well-suited to this time.

Every day, our team accompanies very sick people and their families as they navigate what are often complicated medical circumstances – and are always difficult human circumstances. Our patients face these threatening life experiences with limited information. Under the best of circumstances we can’t reliably predict for them the journey to come.

Before the global coronavirus (COVID-19) pandemic, providing care to people in their homes by video conference was already better than real life (yes, I mean that). Now that COVID-19 is here, telehealth – specifically telemedicine visits by video conferencing – seems to me to be a critical gesture of respect. Respect for the health of people that trust us with their care, respect for each other’s well-being, and respect for the collective well-being of our society.

While telemedicine may be the safest (and sometimes only) choice we have to care for our patients during the pandemic, don’t for a moment think of that as a trade-off. When done well, telemedicine provides something that face-to-face visits can’t – a window to the person, not as a body whose sickness will be deciphered through an H&P, but as a fellow human experiencing fear and needing connection. What follows is my best advice for using telemedicine to create connection.

Get the tech figured out first – and then forget it. Part of this you’ll do in advance. Imagine how your patient will see you on their screen – what else is in the frame with you? Use warm lighting to create an inviting environment, and make sure that your device (phone, tablet or computer) can be settled so that you don’t need to touch it during the call. Elevate the camera so you are not looking down on the camera (and the patient) and are meeting them at the same eye level. It’s the same as you when you sit down to be at eye level with a patient lying in a hospital bed.

When your patient joins you, help them get their device propped up, too. Show respect for the patient by leaning in or out to match the size of your faces in the screen. Acknowledge the awkwardness if your patient isn’t used to telehealth visits – but then move on. If you are stressed about the tech, they will be too, so make sure that you leave your self-consciousness at the ‘door’.

Create a transition. Acknowledge the strangeness of the moment we’re in, and check in on how your patient is feeling: “Ok Lois – wow. There’s something really big happening out there. How are you feeling?”

If your patient is new, this is a great opportunity to use the same semi-scripted introduction you might in your clinic – with one critical difference.

In a telemedicine visit, not only do you see your patient on your screen – but you see your own face as well. This ‘mirror’ brings out the best clinician in me. You will find that you are intentional about your focus on the patient, and the words that you are saying, in a way that just doesn’t always happen in an office when the EHR is open next to you and you’re watching your patient for physical signs.

Remember, you made sure that you and your patient were comfortable enough that you forgot your devices. That means your clinical encounter is just like it would be if it were face-to-face.

Summarize the visit and check in with your patient. For people who like lists, type it up and send it in an email – this creates more contact with the person than a piece of paper, not less. If you make recommendations, invite your patient to email you back to tell you how it went. Email is an electronic trail that can allow the impact of the telemedicine visit to linger after that fact, which makes it an important clinical tool.

Telemedicine via video conferencing is not just a different mechanism for the same encounter. It is a unique and exciting new context for you to offer value and service, and I continue to discover its real advantages and nuances. In this unwelcome and evolving era of COVID-19, palliative care teams have the opportunity to strengthen our ability to use this tool for the sake of building stronger connections with our patients.

The health care system was failing many of our patients before this challenge began. The transformative change that happens when you receive a cancer diagnosis occurs in a blink, and your life is never the same. Ever. I expect that US health care will be transformed, as the muscular forces unleashed by coronavirus unmask the vulnerabilities in our systems and create sea change by necessity.

The impact of COVID-19 on our patients will only be clear from the rearview mirror. For the time being, we must show up for each other in every way available to us, and keep our well-washed hands on the wheel.

• CAPC will be continually adding telehealth and telemedicine tools and guidance to its COVID-19 toolkit. Check back regularly for new information.