A message from Dr. Peter Yellowlees, Chief Wellness Officer.

How to relate to your patients during video visits.
 
UC Davis Health has been getting positive feedback from many grateful patients who have been able to access care through video visits over the past year. Switching to video instead of in-person so abruptly has been disruptive to everyone but most of our providers have done it well, while assuring timely access to care for our patients. With the increasing levels of COVID-19 in our community, it is likely that many of our physicians will need to use video visits more frequently over at least the next few months. Since last April, across all areas of UC Davis Health, we have been doing about 2,500 to 3,000 video visits per week, which is approximately 15% of all our outpatient consultations. While many physicians and other consulting clinicians have found this process easy and rewarding, there are still a number of people who have not really settled into the process. Some clinicians still find doing video visits either difficult for technical or psychological reasons, or anxiety provoking, especially when it seems that the consultations are inadequate through lack of a physical exam, or when some patients do not seem satisfied.
 
I have seen thousands of patients on video since starting teleconsultations in 1991, and have probably experienced almost every possible technical or patient related difficulty at one stage or another, including the wish to do physical exams:
 
It is true that seeing patients on video is a bit different, so here are some quick tips from me:
 

1. Set your stage:
   1. Your attire sends a message, so maintain a professional appearance as you would in person.
   2. Try to present a positive attitude and reassure patients who may not feel comfortable with video visits.
   3. Be sure your background is appropriate
   4. Check your lighting above and in front of you
   5. Try to keep your face centered on the screen with your eyes 2/3rds the way up
   6. Set up your consult note template so that you can start typing from the beginning of the consult
   7. Be prepared to complete the consult by telephone, if you cannot resolve any technical difficulties such as losing the video or audio.
   8. If your video camera or speaker is not working, try rebooting your device.
2. Introduce yourself and explain your role. Make sure you and the patient know who is present - introduce any observers, students, residents, family or others if there are any at both ends.  Make sure doors are closed to provide privacy. If necessary, explain that you have a “hybrid” practice while seeing patients “in-person” and online, and that this is an option you can discuss later, especially if you need a detailed physical exam.
3. Document your patient’s address and cell phone in their notes (which is legally where the consult takes place – you can usually only see patients in states where you are licensed, although during the COVID-19 declared emergency you can see them in any state) and write that you have verbally consented to them about the use of secure video. (A brief verbal consent is fine.)
4. Be confidently positive in the video visits with the patient, even if you do not feel that way, or if there are technical or bandwidth problems. Use small talk to break the ice and aid the patient’s comfort – “Have you done video consults before?” or “Which room in your home are you in?” Be prepared to use the phone, if necessary.
5. Set up a “brief agenda” for the meeting – explain what your aims and expectations are and how long the consultation is likely to be.
6. Try to maintain eye contact with your patients as much as is reasonable during the consult, to encourage a sense of caring. 
7. Proceed with open-ended questions but be prepared to summarize more than usual and alert the patient when you are a few minutes before the end of the consult.
8. If possible, ask the patient to buy their own thermometer, pulse oximeter, or sphygmomanometer from a pharmacy and observe them taking their vitals. You can do several aspects of the physical exam on video while the patient moves around appropriately, at your command.
9. Type your medical notes on an adjacent second screen as you are seeing the patient – this is socially appropriate and saves you time if you can touch type and retain good eye contact. In my view, all clinic rooms should have at least two screens. If you are in one that does not have this set up, you can use your phone (Haiku) or an iPad (Canto) to do the video component with the patient, and type in your notes on the clinic computer. Do not attempt to do the entire consult on just one screen, as this is difficult and slow, and will make the experience frustrating for you.
10. Make sure you put in all your orders while you have the patient available; that the patient knows how to make their next appointment and whether you think it should be online or in-person.
11. Remember video may flatten your emotions slightly, so try to smile and present yourself warmly when appropriate. If you are too serious, video can make you excessively stern or flat.
12. Always maintain privacy for your patients. If someone enters the patient’s room during your consult with them wait until the patient either asks that person to leave or invites them to stay.

Enjoy! The patients will generally find this a very efficient way to be seen and will be grateful. You may find that you can save time by typing your notes as you see the patient. Finally, some of you may wish to discuss the option of working some sessions from home if you can set up groups of video visits consecutively and have good ways of communicating in real time with your clinic colleagues and staff.
 
We can be proud of what we have accomplished during the COVID-19 pandemic and look forward to continuing to support our patients during these challenging times.
 
Thank you for all that you do.

January 13, 2021 / January 27, 2021 - Support U Peer Responder Program Workshop

Dr. Christian Sandrock, UCDMG Davis Pulmonology

Dr. Ellen Yang, UCDMG Carmichael Internal Medicine

Dr. Katerina Christiansen, Community Physicians Internal Medicine

Dr. James Brandt, Ophthalmology ACC

Dr. Cassandra Lee, Sports Medicine, Orthopaedic Surgery