How providers can fine-tune their ‘webside’ manner in the age of COVID-19 Insight Article - June 19, 2020 Patient Engagement Patient Care Technology Sign in to save Mia Finkelston MD When COVID-19 started spreading like wildfire in early March, no one realized how quickly we would be forced to adapt our lives and the traditional practice of medicine. While hospitals in hotspots struggled to stay afloat amid a surge of patients newly diagnosed with COVID-19, ambulatory providers found themselves upended from their routine patient encounters, and had no choice but to adopt or at least consider telehealth. In recent months, virtual visits have surged and are expected to exceed 200 million this year, much higher than projections.1 This growth is on pace with the spread of COVID-19, which has infected more than 2.2 million U.S. residents, as of June 2020.2 This shift to telemedicine has forced many providers out of their comfortable office or hospital setting and into an unfamiliar digital world. With more patients using telehealth than ever before, even physicians with telehealth experience are finding it challenging to keep up with the demand brought on by COVID-19. One thing hasn’t changed: the importance of the patient experience. Whether providing care in person or online, the patient experience and the quality of care delivered needs to be a priority. Yet, providing an optimal experience via telehealth requires different techniques than an in-person visit. Webside manner, the virtual equivalent of bedside manner, is not often taught, especially during times of crisis, yet it can make or break a patient’s virtual healthcare experience. Webside manner: Why it matters Doctors with good bedside manner demonstrate empathy and compassion and connect to patients while giving care. Numerous studies have shown the benefits of good bedside manner, including how it can decrease the likelihood a physician will face a malpractice lawsuit.3 Most importantly, proper bedside manner can also influence a patients’ health for the better.4 Research has shown that a doctor's bedside manner can aid in patients’ efforts to manage chronic conditions, including losing weight, lowering blood pressure and managing painful symptoms. Similarly, a doctor’s webside manner during telehealth consultation can have a profound effect on a patient’s medical outcomes (e.g., the ability to follow a treatment plan to recover from a debilitating medical condition) or satisfaction. The pandemic has led to isolation and uncertainty, while increasing patients’ needs for compassion and empathy. A little virtual handholding can ensure patients receive the best care possible, whether they are being directed to a coronavirus testing station or simply urged to consider telepsychiatry for ongoing mental health issues. Having a good bedside manner doesn’t always translate to having a good webside manner. In the virtual realm, the parameters by which a physician is judged are a little different. Curating your webside manner Here are six best practices for physicians who want to brush up their webside manner: Be mindful of telepresence. Even the best physicians may not be able to build patient rapport with their webside manner if they don’t fully consider their telepresence — a term that refers to how they’re perceived through a screen. For example, for the patient to feel as though the provider is making eye contact, the physician may need to look directly into the web camera, not at the patient’s eyes on the screen. If the doctor isn’t accustomed to looking into the camera, he or she can come off as aloof or uninterested. Overcommunicate. First-time patients especially will need some additional instruction to ensure a successful visit. It’s important for providers to tell patients to share as much as possible — photos, medical history, etc., can all be helpful for a proper diagnosis. Patients may also need to adjust camera angles or assist in the examination in ways that are new to them. It’s a provider’s responsibility to guide patients through this process and communicate what needs to be done and why. This will help patients build confidence in their provider and in receiving care virtually. Ensure a private environment. Patients want to know that even when a doctor is providing care at home, their privacy is being maintained. This may require a little more effort by the provider. Consider showing first-time patients that you’re alone, in a private space with the door closed. Additionally, potential disruptions and distractions, such as instant-messaging applications or email inboxes, should be minimized or closed, so a virtual consultation will not be interrupted. Keep the setting and your appearance professional. Regardless of where a telehealth consultation originates, the physician must maintain a professional look and feel. Also, while you don’t have to dress to the nines for a telehealth encounter, dressing professionally — for example, wearing an ironed button-down shirt or a white coat, just as you would when seeing patients in the office — helps make the experience synonymous with a brick-and-mortar one. Come prepared. As one study suggested,5 the introduction of computers into exam and treatment rooms may have had a negative impact on physician engagement because it took physicians’ eyes off the patient in the room. Whenever possible, have the patient’s medical chart and health history close at hand at the beginning of a consultation. This helps to avoid trying to navigate data fields in an EHR or scrolling through the patient’s lengthy medical history during the visit. If you do need to look down during a visit, let patients know that you’re just taking notes or consulting a resource so they know you’re still paying attention. Beware of “doorknob” moments. Closing a telehealth connection without properly signing off is like closing a door as a patient makes a comment or asks a question. It’s important to end every visit by making sure patients have a clear treatment plan and don’t have further questions. Providers should also give patients a way to follow up if questions arise down the road. While the adoption of telehealth grew considerably in response to COVID-19, we will only be able to maintain and grow its usage if the patient experience and quality of the visit remains high. Strong webside manner is key to ensuring that patients are not only satisfied with their telehealth visit but chose to keep coming back online even after the pandemic subsides. Learn more Check back at mgma.com/research-analysis at the end of June for MGMA’s latest Research & Analysis report, Optimizing Telehealth During COVID-19 and Beyond, for operational insights and best practices for long-term success in virtual care delivery. Notes: 1. Coombs B. “Telehealth Visits Could Top 1 Billion in 2020 Amid the Coronavirus Crisis.” CNBC. April 4, 2020. Accessed April 24, 2020. https://www.cnbc.com/2020/04/03/telehealth-visits-could-top-1-billion-in-2020-amid-the-coronavirus-crisis.html. 2. Coronavirus (COVID-19) Update, World Health Organization. Accessed June 8, 2020. https://covid19.who.int/. 3. Levinson W, Roter D, Mullooly J. “The Relationship With Malpractice Claims Among Primary Care Physicians and Surgeons.” JAMA Network. February 1997. Accessed April 24, 2020. https://jamanetwork.com/journals/jama/article-abstract/414233. 4. “Study: Physicians’ bedside manner affects patients’ health.” The Advisory Board. April 14, 2014. Accessed April 28, 2020. https://www.advisory.com/daily-briefing/2014/04/14/study-physicians-bedside-manner-affects-patients-health. 5. Alsos O, Das A, Svanæs D.“Mobile health IT: The effect of user interface and form factor on doctor–patient communication.” Journal of Medical Informatics. January 2012. Accessed April 28, 2020. https://www.sciencedirect.com/science/article/abs/pii/S138650561100195X?via%3Dihub.