Doctors and nurses are often praised (or admonished) for their bedside manner. But in today's mHealth-flavored world, do they have to have a different skillset for delivering care via telehealth?
In a word? Yes.
"You can be a great physician and not be a great telemedicine physician," says Randy Parker, CEO of MDLIVE, a Florida-based telehealth provider. "You need a 'desktop manner.' It's a different level of skill that you never learned in medical school."
Your actions and reactions are much different if you're in a room with a patient, as opposed to communicating with one over a video feed or via e-mail or text. And yet, if you're delivering healthcare, each of these situations has to be treated with the utmost care. You can't be any less attentive or diligent just because you're in another location.
"There's a whole comfort level and professionalism involved (in telehealth) that many doctors don’t get," says Parker, who estimates that about half of the nation's doctors aren't getting it right. "There's even a dress code, and a way you present yourself" in a video encounter.
It all boils down to that popular catchphrase: Patient engagement – or, to be more accurate, consumer engagement, since telehealth doctors may be interacting with people who aren't their normal patients. That's important, because a doctor who doesn't look comfortable or isn't engaging in an e-mail or video encounter runs the risk of losing that consumer as a patient – or, worse, having that consumer become so disengaged as to reject or ignore whatever diagnosis or medical advice is offered.
Peter Antall, medical director of the Online Care Group, which supplies doctors for American Well's telehealth platform, says doctors are subjected to a rigorous schedule of e-learning modules and one-on-one training on "webside manner" before they begin working for American Well – and then can face ongoing training and "secret shopper" evaluations going forward.
Antall says online doctors face two unique challenges that they don't encounter in the exam room. First, they should have a familiarization with the technology they're using, in case the patient on the other end of the encounter isn't tech-savvy and needs help. Second, they have to learn "how to evaluate patients without the ability to examine by touch."
"Particularly when practicing minor acute illnesses or injuries, behavioral health or chronic disease management most of the information needed to make a diagnosis or triaging a patient can be obtained by speaking to the patient (taking a medical history) and by performing a telehealth exam (visualization, use of the patient to assist)," Antall said. "Developing these skills requires a physician to be open minded and willing to learn and grow."
Online care is a relationship-based system, much like Facebook, and requires a different dynamic than in-person care, according to Ron Gutman, CEO of HealthTap, a newly launched online concierge care service.
"You can't just connect with anyone," he said, adding that online care might even be more quality-intensive than in-person care because of the challenges of dealing with a patient in a different location. "You have to understand the dynamic."
Ryan McQuaid, CEO of PlushCare, another newly launched concierge care service, says online care "isn't necessarily something that can be taught," but requires a certain kind of innate skill to project over a video screen or through an e-mail/text encounter (not unlike acting, actually). "You have to be outgoing, and comfortable with technology," he says. "Certainly there are doctors out there who are amazing physicians when dealing in person with a patient, but they just don't do well" in a telehealth setting.
For small telehealth startups, having the right doctor at the other end of the line is a crucial selling point. HealthTap offers consumers the opportunity to link their personal physicians into the network or choose from a stable of carefully vetted and trained physicians, while PlushCare boasts "online doctors educated at world-class medical schools Stanford and UCSF."
They key is to make the consumer comfortable with the clinician at the other end. And that puts all the pressure on the clinician. One wrong move, one disingenuous comment via text or action caught on video, and the consumer can shut the whole conversation down and walk away from telehealth with a bad taste in the mouth.
In some cases, says Parker, health systems or clinics hire a physician to specifically handle telehealth encounters.
"The whole concept that has changed is patient satisfaction," he said. "It's customer service, something they may never have thought of before, but it's big now. Consumers have more money in the game. It may be more than just a small co-pay, more like a high deductible, so they want to make sure they get it right."