For many pediatricians, the idea of performing that first virtual healthcare visit can cause great anxiety. This isn’t surprising when you consider the vast majority of physicians (in pediatrics or any other practice area) haven’t been trained in the nuances of telehealth – a topic that is just now finding its place in modern medical school curricula.
If you’re among those wondering how virtual care really works – i.e. what to expect, how to get started, and what you can do to encourage patient confidence – these tips will help.
Step 1: Introductions / Greeting
It’s important to take a moment to greet your patient, just like you would in a traditional clinical setting. If you are new to the patient (perhaps they’re new to your practice or typically see one of your partners), introduce yourself – share your name, title, specialty, and relationship to their regular doctor (as appropriate). It also never hurts to let them know your location.
Ask the caller to confirm the patient and parent demographics, including current location, and the primary care provider’s name. (Remember, you must be licensed to practice in the state where the patient is currently located.) It’s also a good idea to get a verbal consent for treatment, even if you have a “technology consent” on your software platform.
Step 2: History
Just as you would in a traditional medical setting, ask for the chief complaint / primary concern, including onset, duration, severity, and symptoms.
Next, review your patient’s medical history and ask for more details, as needed. Of course, you may want to skip ahead if the parent / caller is highly concerned, or if the chief complaint sounds urgent. You can always circle back after your initial assessment.
Step 3: Assessment
Unlike in an office setting, you may not see your patient right away, as the camera may be focused on the parent in the beginning. Also remember that your patient likely hasn’t been triaged by a nurse, so no one has seen the child prior to your visit. This said, it’s important to perform a quick visual assessment of the child as soon as possible. Check the child’s general appearance, breathing, and circulation to ensure he / she doesn’t need an immediate referral.
Once you’ve determined your patient doesn’t need an emergency referral, begin your focused assessment of the area of concern. This might also include examining the child’s living conditions and/or environment.
Step 4: Advice, Treatment and/or Plan
Once you’ve completed the assessment of your patient, it’s time to determine next steps and offer guidance. Does the child need to be triaged to a higher level of care tonight, or come to the office tomorrow? Or is this something you can diagnose and treat via telemedicine? For example, does the rash require little more than a prescription? Or is this clearly a virus that needs nothing more than reassurance and guidance?
Step 5: Closure
Similar to an after-hours telephone call, you can’t rely on a nurse to hand deliver discharge instructions or review questions and concerns. So, it’s vital that you make sure the parent / caller understands your instructions. Summarize the diagnosis, advice, and instructions on next steps, and then have the parent / caller repeat what they heard back to you. It’s also good to confirm the parent / caller intends to follow the treatment plan.
Last, But Not Least
If you’re still nervous, perform some practice visits with family, friends, or colleagues using FaceTime or Skype. You can even record these practice runs to assess and improve your skills. And, remember, you care for patients and talk to parents all the time in the office. In many ways, virtual care calls on the same skills, so just jump in and know that your comfort level will grow fast.