Communication Skills during Telehealth Consultation

What to do? 

•Greet with a pleasant opening sentence 

• Stay attentive 

• Ask the patient if they want to use audio call or video. 

• Should wear your labcoat. Should be in a well lit and quiet room. 

• You can take a minute or two to explain the patient how telehealth clinic works ( probably its there first experience )

• Start with appropriate open ended questions, keep your tone neutral. 

• Patient centered: Patient should be allowed to talk for at least 60% of the time, followed by directional and close ended questions.

• Ask relevant questions in the history.

Ask relevant personal and psychosocial questions + medication +any investigations (previously done)

• If relevant, ask questions to exclude alarming symptoms (red flags)
• Summarize and clarify

Ask Ideas, Concerns & Expectations (ICE) at the end e.g. ‘Is anything crossing your mind, what might be causing it’? ‘Is there anything which is especially bothering you regarding the seriousness of your complaint?’ ‘This information may help me to address the problem to your satisfaction’ Be careful with your time management – practice, practice and practice.
Ask for vitals where necessary, Ask for pictures to make the right diagnosis (skin problems or injuries ,swellings etc.)

 What not to do? 

1.   Interrupt the patient inappropriately. Be abrupt and rude 
2.  Become too tense and anxious.
3.  Talk too much and miss or ignore patient’s cues 
4.  Be doctor – centered most of the time 
5.  Be hesitant or over confident. 
6.  Forget summarizing 
7.  Not asking for pictures where necessary to make your diagnosis
8.  Not addressing patient’s concerns
9.  Not explaining the reasons for the investigations, f/u, or referral. 
10.  Forget to clarify from the patient.
11.  Asking close ended questions from the beginning.
12.  Asking too many irrelevant questions.
13.  Be disorganized.
14.  Not taking PROMPT actions for patients with serious diagnosis e.g. hospital admission/ ER referral
15. No safety- netting at the conclusion of the consultation
16. Advising to perform interventions on call. 
17. Please refer where necessary.

EXAMINATION 

Take time to ask about the issue and ask for pictures where necessary. Assure the patient that the privacy will be maintained.
Utilize video call whenever possible.
If you think vitals must be checked , do inquire if they have thermometer, BP apparatus , Smart Phones /watch which have sensors for pulse and oxygen saturation measurement.

TIME MANAGEMENT 

Time management is very important : When you have gathered enough information through the patient centered mode, shift into a moderately doctor centered approach.Identify the focus of a consultation quickly and do not spend time down blind alleys. Be more proficient at closing consultations.

Making a Diagnosis 

• A focused examination in response to the information gathered in the history may help in making an appropriate diagnosis and D/D (since we arent able to do examination hence we might not be able to treat all the ailments, don't be over zealous, if You think patient needs examination for diagnosis then refer)
• Make sure, you clearly explain to the patient what investigations you want to request and why?

Explaining the Diagnosis 

• Three important principles:
•Check what the patient already knows
•Tailor the explanation to the individual patient
•Check whether the patient has understood your explanation. e.g. ‘Is all that clear to you,-(Pause) or should I go over it again, as I may not have explained it properly.

Making a Management Plan

• Explanation and reassurance – non pharmacological
• Pharmacological (prescribing)?
• Referral to a specialist or any other source?
• Early Follow up or Plan followup + safety- netting
• Hospital admission?

Your Attitude / Behavior 

• A positive mental attitude is vital
• Visualize clinical skills assessment as a challenge rather than as a threat
• Try to be as relaxed and natural as you can
• Concentrate entirely on the patient
• Be nice to the patient and focus on solving his problem
.

Reference: MRCGP southasia website,  altered few points with respect to telehealth limitations
http://www.mrcgpintsouthasia.org/pdfs/OSCE_Preparation_Tips.pdf