Practice of Medicine

Article

Webside Is the New Bedside: Best Practices for Virtual Patient Visits

By: Asha Patel Shah, MD, FAAD

April 19, 2021

Bedside manner is truly an art, and its success is rooted in the personal interaction and rapport that is built between patient and physician. With telemedicine being pushed to the forefront, “webside manner” is emerging as the virtual analog and becoming an important skill to create and maintain a trusting patient relationship.  

Developing a webside manner, or online personality, is a challenge for nearly one-third of physicians.1 With the rapid incorporation of telemedicine into healthcare, your webside manner is the only representation you have to properly communicate with patients. Optimizing your virtual presence creates assurance in clear communication – one of the key factors in reducing litigation risk and increasing patient safety.2

Webside manner encompasses a large breadth of communication that may include: e-mail, texting, portal/medical record messaging, audio calls, and video calls. Trying to translate a human touch over technology is a learning curve but is important for patient outcomes and patient satisfaction.  

Lights, Camera, Action

Appropriate lighting is essential to put your best face forward. Face your brightest source of light in the room – using natural or artificial lighting directly facing you will decrease the chance of shadows.

The camera’s height on your device should also be on the level with your central face. You will most likely have to raise the height of your device so you don’t create an unflattering angle of yourself.

Whether we like it or not, your credibility as a physician also hinges on your attire. As such, opting to wear professional clothing sets the tone for the visit and helps the patient garner a positive impression of your abilities and communicate your authority.

Ensure your background is de-cluttered, professional, and simple. Avoiding doors in the video frame or distracting objects in the background will ensure a private environment that will create trust between you and the patient.

The room itself should be enclosed as much as possible to reduce noise pollution and echo.  Wearing headphones will increase your patient’s privacy and help secure the environment in a HIPAA-compliant manner.

Finally, checking your tech before you go live ensures there are no hiccups in communication. Testing your internet connection, microphone, and camera function beforehand decreases the chance of frustration and lost communication.

Getting Started

Just like an in-person encounter, your virtual introduction is your first impression. A friendly greeting that confirms your name, your role, and the patient’s name helps set a warm and professional tone. Even though you are virtual and it might be easier “to get down to business,” take a pause to invoke some social pleasantries. Doing this brief introduction will not only convey politeness and replicate an in-person visit, but also concurrently check the patient’s connection and audio-visual equipment to ensure that both parties are properly set-up for the call and are comfortable. It is also advised to ask the patient if there is anyone else within hearing distance on their end to ensure that you are abiding by privacy laws and HIPAA compliance.

In addition, eye contact is now the new handshake. Practice getting your eyes on the camera lens, as opposed to the patient’s face somewhere on your screen, to help command your virtual presence.

Be aware of your body language during the encounter – don’t slouch, cover your mouth, cross your arms, or lean back. These motions can be misconstrued as unprofessional or uninterested towards your patient. Best practices include an upright posture, open chest, leaning forward, nodding periodically, keeping your face forward and free of obstruction, staying seated, and keeping any hand motions within full view of the camera.

On-Screen

Try to avoid fidgeting! Sometimes we subconsciously tap our foot or click a pen. Keep in mind two things: the patient can’t see what you are doing and device microphones are highly sensitive. Not only is extraneous movement distracting to the patient, it can also hinder advice given and thus decrease  
the perceived quality of your medical visit.

Eating and drinking on camera are not well received by patients. Not only does the sound of it get amplified by the microphone, but it also makes the visit appear too casual as this behavior would not normally be done if it was an in-person encounter. It is best to avoid this altogether, though if you must offer a quick excuse then eat or drink with your camera/microphone turned off.

Despite the fastest and strongest internet connection, there can be delays in receiving audio/video input. This can create frustration, especially when it results in a natural conversation between both parties becoming choppy. The best practice is to listen with the intent to get the full story from the patient and prepare to paraphrase in your words and repeat back, allowing for a pause that might be more than you would allow in-person. Due to technology lag, it is also best to avoid long-winded sentences. Practice succinct medical counseling and leave room for frequent pauses to get patient feedback.  

Decreasing medical jargon usage can also help decrease confusion and unnecessary back-and-forth questions. Ensure that you have circled back to the patient’s reason for the visit to convey thoroughness. Allowing for the patient’s expectations to align with yours is key for a positive partnership.

If you plan to use the same device to video conference with the patient and look up medical information during the visit, be sure to tell the patient what you are doing. Your eyes and attention will be elsewhere while the patient is still seeing you – a brief explanation on the front-end can help reduce their concern and keep them in the loop.

It’s a Wrap!

Once the call is winding down, you should summarize the treatment plan and next steps. It is advised to keep track of your time on the call to avoid the trap of falling behind. This requires a pre-planned strategy as most in-person visits are shuttled along with the help of your medical staff. With telemedicine, the onus is typically on the physician to stay on track and be fair to your next patient. Most find a timer that rings five minutes before the close of the visit is a helpful tool to both patient and physician to signal a conclusion.

Leaving time for patient questions is a must, just like you would allow during an in-person visit. Instructions regarding any after-visit paperwork can be given at this time, as well as a courteous goodbye as a signal to end the visit. Be sure to know where the appropriate button is to officially end the visit. Sometimes, just closing out the screen may not end the encounter and your camera and microphone might still be rolling!

With the adoption of an effective webside manner, you can greatly enhance your virtual presence and start to take command of telemedicine. As telemedicine becomes assimilated into routine healthcare, the benefits of presenting your best virtual self will certainly pay off!

 

1. Drees, Jackie. “Nearly one-third of physicians say developing an online personality, 'webside manner' is a top challenge for telehealth.” Becker’s Hospital Review; 2020

2. Lester GW, Smith SG. “Listening and talking to patients. A remedy for malpractice suits?” West J Med. 1993 Mar; 158(3): 268–272.

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Disclaimer

The information provided in this resource does not constitute legal, medical or any other professional advice, nor does it establish a standard of care. This resource has been created as an aid to you in your practice. The ultimate decision on how to use the information provided rests solely with you, the PolicyOwner.