FaceTime with my mother would be better described as ForeheadTime. She loves to use video for our Sunday calls, yet when she does, she always talks into her iPhone as if it’s a speakerphone. As a result, all I see is the top of her head. “Mom. Lower the phone. Mom, I can’t see you,” I must repeat weekly.
Video provides a richer experience compared with telephone. It allows for a deeper, emotional connection. That’s why moms like mine prefer it to telephone conversations. In medicine, video visits are uncommon, but that’s changing as payers are now reimbursing and patients are demanding the service. For many, they offer a far more convenient and still effective method to receive medical care. Psychiatry is an obvious example. Less obvious, but still effective examples, include endocrinology, pediatrics, primary care, surgery (post operatively), and dermatology.
Like the example with my mom, quality of the experience matters, and issues often arise not from the technology, but from the technique. Making eye contact is more difficult on video, and not looking patients in the eye can harm doctor-patient bonding. Here are a few basic tips when using video with your patients:
• Be sure the light source is in front of you. Having windows behind you often puts you in shadow.
• The best place for the camera is at the top of your screen. It’s nearly impossible to look into the camera and see the patient if the camera is next to the screen instead of above.
• Remember, to look directly at the patient, you have to look into the camera. This is tricky and easy to forget.
• Be sure your entire head and upper torso are in the frame. Talking heads can be intimidating.
• When possible, use a headset with a microphone. Headsets help both you and your patient hear better and give the patient an increased sense of privacy.
• Generally speaking, video visits take as long or longer than in-person visits. Remember to be patient as some of your patients may experience technical difficulties. Our IT colleagues have a word for it: “picnic,” which stands for “Problem In Chair Not In Computer.” You should also train your staff to aid you and the patients. For instance, if a patient is struggling with the computer, you might have your assistant help him or her while you move on to the next patient.
• Although the patient can be home, it is best for you to be in your office. It’s possible to do video consults from home, but it is more difficult because you have to ensure that both your technology and your environment are secure and private. Otherwise, you risk violating HIPAA or other compliance requirements.
• Be sure to get the appropriate consent before conducting a virtual visit. In California, it requires only verbal consent, but your state’s requirements might be different.
• As for your appearance, there’s a reason why Kennedy won the Kennedy-Nixon debates. Video does reveal details that you might not want emphasized. A two-day beard might appear hip in person but unkempt and uncaring online. Bold stripes or checks on your shirt sometimes appear distorted, so opt for solids in soft shades. Scrubs are okay, but be sure to check your neckline, particularly as you move about. Whether it’s clothing or accessories, avoid anything overly distracting.
Video visits have had a long, slow ramp-up, but they seem to be gaining momentum. You may not use them in your practice now, but it’s likely we all will someday. Soon.
Dr. Benabio is a partner physician in the department of dermatology of the Southern California Permanente Group in San Diego, and a volunteer clinical assistant professor at the University of California, San Diego. He is @dermdoc on Twitter.
