Communicating with Patients in a New World of Virtual Visits

Three months ago, only about 2% of Cleveland Clinic patient visits were done virtually, by video chat. But then the COVID-19 pandemic hit, and virtual visits shot up to 75%.

While in-office visits will resume as physical distancing restrictions ease, virtual visits are here to stay, says Amy Merlino, MD, Chief Medical Information Officer at Cleveland Clinic.

“I don’t know that we will continue at 75%, but somewhere between 50% and 70% is likely for ambulatory care,” she says.

In addition to quickly adapting to new telehealth privileges, platforms, documentation and workflows, clinicians have needed to learn new ways of communicating with patients during virtual visits.

“Not being in the same room with the patient changes how we connect with them and relate to them,” says Dr. Merlino. “We can’t show empathy by touching them, for example. We need to learn new ways of reassuring patients that we hear them and care for them.”

Guidelines for digital health communication

In response, Cleveland Clinic’s Center for Excellence in Healthcare Communication led the charge in establishing guidelines for digital health communication:

• Empathy in Virtual Visits.
• Top 10 Tips for Virtual Visits Clinician Communication.

Both documents were released in April as part of Cleveland Clinic’s Digital Health Playbook.

“One of the biggest challenges for clinicians is their initial uncertainty and discomfort with using virtual technology for patient care,” says clinical psychologist Amy Windover, PhD, Director of Communication Skills Training in the Office of Patient Experience at Cleveland Clinic. “It’s new to everybody. Clinicians are desperate for guidance because there is a steep learning curve without some basic training.”

Be more intentional about establishing relationships

As reflected in the new guidelines, clinicians need to be more intentional about establishing and developing patient relationships during virtual visits, notes Dr. Windover.

“Given the novelty of virtual visits, there’s a risk that clinicians will skip the formalities and try to get right to the point of the visit,” she says. “But that’s like hosting a dinner party where you don’t welcome your guests or hang up their coats, but rather hurry them to your dining room, start passing the dishes and then rush them out the door.”

Taking time to connect with the patient and convey value and respect is especially important when you’re not physically with them. Dr. Windover recommends these simple techniques:

• Ask if the patient is new to virtual visits. If they are, briefly review the benefits — such as convenience and safety — and normalize any discomfort they may have with the technology.
• Look at the camera (rather than the screen) to simulate eye contact. It may appear to the patient that you are looking down when you are actually looking at the patient on screen. Address this with the patient up front, so they don’t interpret your lack of eye contact as disinterest. Even better, reposition your camera to better enhance your face-to-face connection.

Convey empathy verbally and visually

During in-person visits, clinicians may rely on nonverbal cues — like nodding, leaning forward or raising eyebrows — to show empathy. During virtual visits, nonverbal cues may not be as effective due to audio or visual lag time.

“Verbally addressing a patient’s feelings is important in person, but even more important virtually,” says Dr. Windover. “Patients need to hear healthcare providers say that they care about and respect them. Only then will patients trust us enough to share complete information about their symptoms or experiences. And that is vital for us to accurately diagnose and treat their condition.”

For example, empathic statements include:

• “I can hear how hard this has been on you.”
• “It sounds like you’ve had some difficult days recently.”
• “I would feel frustrated as well.”
• “I’m excited about your progress too.”

“There’s a lot of research that says physical touch is helpful in connecting with patients,” says Dr. Windover. “But we can still convey that without physical contact. Putting your hand over your heart, for example, or touching your own arm like you’d touch a patient’s arm are effective ways of showing empathy visually.”

Just be sure to make nonverbal cues like these larger and slower than you would in person, she says, making them more prominent on camera.

Priceless information instantaneously

Developing a relationship with a patient actually may be easier via virtual visit, notes Dr. Windover. Observing patients in their regular environment — with kids popping in unexpectedly or a collection of books in the background — can help clinicians forge a more immediate and personal connection.

“Watching the family interact or seeing that the patient is still in their pajamas is valuable,” says Dr. Windover. “You can get priceless information instantaneously through virtual visits.”