When we interview doctors for telehealth jobs, one of the most common questions is: What’s it like to interact with a patient using a robot?
The short answer is that performing a history and physical (H&P) exam using a robot is very similar to in-person H&Ps. Onsite staff receive training on how to inform the patient about what will happen during a telemedicine visit and the nurse is on-hand to support the patient and the remote physician during the clinical evaluation.
Before you accept a telehealth job, you want to know you will be comfortable caring for patients via technology. Let’s walk through the process.
Step 1: Bringing a Robot to the Patient
After the nurse coordinates with the telemedicine provider to determine that a patient needs a consult, the nurse moves the cart into the patient’s room. The nurse tells the patient that a remote physician will be performing an exam and answers any questions the patient may have about telemedicine.
Then, the nurse opens the telemedicine video application, connects the electronic stethoscope (eStethoscope) and positions the cart at the end of the patient’s bed. The video connects using the hospital’s secure Wi-Fi connection and a secure video application. Within an instant, the remote provider appears on the screen.
Step 2: Introducing the Telemedicine Doctor
The patient exam begins with an introduction from the telehealth provider. The remote doctor reassures the patient that the nurse will act as the doctor’s hands during the exam. Here is a sample introduction from a TeleHospitalist:
Hi, my name is Dr. [NAME]. I am board certified in internal medicine doctor. We are using robotic technology to communicate tonight. We use this technology because there’s a shortage of physicians in the United States. We don’t want you to wait for care.
I’ve already had the opportunity to review your chart and discuss your case with the emergency department doctor who did a great job taking care of you. Your nurse will be here the entire time, and act as my hands during the exam.
Is it okay with you that we use telemedicine to perform your exam today?
It’s very rare for a patient to decline telemedicine. Most of our physicians have never had a patient decline care. In fact, patients are often impressed with the technology.
Step 3: Connecting with the Patient
Eagle trains our physicians to reassure the patient that they are in good hands. We emphasize webside manner, which is our way of empathizing with the patient. Telemedicine providers working with Eagle learn how to make good eye contact, use hand gestures over video and adopt a soothing tone of voice to help the patient adjust to talking to a robot.
At this stage, and several times during the examination, the remote doctor asks the patient if they have questions. This is a vital part of the telemedicine exam because it makes the patient feel “heard” by the remote provider.
We also coach our providers to repeat back patient responses to confirm symptoms. This is often part of a face-to-face exam. In a remote care environment confirming the stated symptoms is particularly important. Often the patient needs time to adjust to talking with the robot. Here’s an example of symptom confirmation:
Telemedicine Provider: I want to make sure that I understand you symptoms. You are experiencing pain in your left eye and blurred vision in both eyes. Is that correct?
Patient: Yes, it’s my left eye that hurts but it’s hard to see. Things are blurry in both eyes.
Telemedicine Provider: Are you experiencing pain anywhere else?
From here, the telemedicine provider may proceed with an eye examination or zoom-in using the robot’s high resolution camera to exam the patient’s eyes.
Step 4: Completing the H&P
The history and physical is a critical element in the overall diagnostic process the H&P is the patient story and a representation of the physicians clinical workup that has been completed
What’s really great about the physical exam is that it allows doctors working telehealth jobs to develop a relationship with the onsite nurses. Our providers work in small teams at a few hospitals, rather than a large pool of facilities. This allows our virtual physicians to get to know the staff, which makes performing the patient exam much easier.
The stethoscope technology is really amazing in terms of audio amplification and quality of the sound. The nurse assist with the placement of the eStethoscope. When the physician is ready to listen to another area of the lungs, heart or abdomen, they ask the nurse to move the stethoscope.
“Sometimes I have to take my headphones off my ears because a murmur is just so loud that the sound can be pretty amplified,” says Dr. Elmira Basaly. “It’s like having an EKG right there in front of you while you’re listening. In telemedicine you’re at a broader advantage – you’re not just looking at the patient’s chest you’re at the back of the room the nurse is putting the stethoscope on the patient so you can see the monitor. I can correlate the patient’s heart rhythm and rate. I always find that to be reassuring especially when someone’s presenting with a rapid heart rate such as atrial fibrillation you can hear and see that algorithm at the same time.”
During the abdominal exam, the nurse will palpitate the patient while holding the electronic stethoscope. The doctor can hear as clearly, sometime more clearly, than a patient exam performed with a traditional stethoscope. Eagle providers work with the nursing staff to ensure the exam is thorough. For example, a TeleHospitalist might ask the nurse to push down with an eStehoscope while the TeleHospitalist is listening. The nurse is also able to supplement with a deeper palpation if the patient has reported tenderness.
The high-resolution camera allows the doctor to zoom in really close to the patient’s face during a neurological exam. The patient is asked to raise their eyebrows, push out their cheeks and provide a big smile while the TeleSpecialist looks for facial symmetry. Some robots enable the physician to show pictures to allow for short-term memory assessment. In other situations, the remote physician will hold a common item on image up to the video screen.
“The physical examination is pretty complete,” says Dr. Basaly. “In my opinion, heart, lung, abdomen, neurological and skin assessments can be easily viewed and auscultated. Some of the robots have really cool attachments where you can do skin examinations or have an otoscope, or an ophthalmoscope attached.