With the COVID-19 pandemic placing new strains upon in-person doctors' appointments, both clinicians and patients have increasingly relied on telehealth and other virtual technologies to maintain a connection to care.
Beyond their immediate role in the public health emergency, these modalities have the potential to upend the delivery of care, said Dr. Katharine Lawrence, a healthcare delivery science fellow in the NYU Grossman School of Medicine's Department of Population Health, said today in a Patient Experience Digital Series keynote.
But to get there, providers need to be aware of how they conduct themselves during a telehealth visit, and should understand that their abilities to connect with patients on a human level don't necessarily translate to a digital screen.
"What I noticed early on about the new virtual frontier in healthcare was how the patient stories we were sharing were changing," she said during the keynote. "Increasingly we were recounting our technical frustrations, our communications challenges, how we were navigating the lack of physical exams or other restrictions, and just how altered our sense of the patient-provider relationship was becoming. We were clearly struggling as a community with how to approach this new environment, and looking to each other to guide best practices."
These disconnects are being felt on the other side of the call as well. Patients, she said, are becoming frustrated with physicians that they perceive as indifferent, curt or disinterested. They cite specific mannerisms such as infrequent eye contact, off-screen distractions and consistently short visit times as contributing to these impressions – and that's before factoring in the larger challenges of language barriers, privacy concerns and inequitable access to telehealth-compatible devices.
For many patients and providers, the rapid shift to virtual technologies came at the cost of clinicians' ability to generate and express empathy, she said. However, that doesn't mean that telehealth is doomed to continue as an impersonal exchange of services.
Empathy in healthcare is very much a teachable skill in medicine, she said, and a body of literature has highlighted including simulated patient encounters, communication skills and the creative arts as clear interventions to improve in-person empathy skills. With this body of work as a starting point, she called for the medical field to begin investigating how telehealth clinicians can be taught to foster a connection through the web.
"Just as we've worked to define and study empathy in physical spaces, we need to study empathy in the unique context of digital spaces, because it's not enough to simply take what we know about empathy and virtualize it, and assume everything will just transfer," she said.
"We've seen this in building our capacity during the pandemic, where so much of our understanding of what it means to be an empathetic physician has been challenged. ... We need to be able to identify competencies and skills, explore barriers and facilitators, and address the consequences both intended and unintended for care delivery and experience."
The burden of achieving empathetic virtual care isn't limited to clinicians, however. Lawrence said that those building new technologies must also design their systems in a way that is sympathetic and speaks to the patient on their own terms.
This type of approach is already present in patient-facing chatbots, cognitive behavioral therapy apps and targeted, automated communication services, she noted. It's up to technologists to keep these values in mind when innovating the rest of the virtual care landscape – just as it's up to the healthcare system as a whole to stress the need for more attention into digital empathy.
"How can we make tools that amplify human empathy, and how can we be sure we are prioritizing building those kinds of tools? The answer probably isn't as simple as adding a 'care' emoji to our telemedicine platforms – although I'm not opposed to trying it," she said.
"It will take research and patients – and a whole lot of human-centered design – to figure out how to amplify the best qualities of people through technology, while actively combatting the deleterious effects we've seen.
"The only way we build that kind of technology is if we as clinicians, technologists, advocates and leaders agree that it's crucial to do so," she said.