Solid technology is the foundation of any successful telemedicine program, but there is another vital factor, of course: physicians. At Eagle, we hear a lot of praise for the ones who are part of our team, for their ability to make a personal connection with patients, families, and staff―no matter how great the geographical distance between them.
That connection doesn’t happen by accident.
We know many excellent physicians who are great at the work they do…but they aren’t the right fit for telemedicine. We certainly don’t recommend it for everyone.
Telemedicine physicians must be good clinicians, of course. But they also must possess three other qualities that make the difference between an unsuccessful telemedicine encounter and a successful one. We find the following checklist helpful for any physician considering going into telemedicine practice, or any hospital executive or medical director considering a telemedicine program and searching for a quick way to evaluate the physicians involved.
1. Communication: A good “webside” manner
Every physician must be a good communicator, but telemedicine physicians must go beyond the norm.
Because two-way, audio-visual technology is the communication medium, telemedicine doctors can’t rely on body language to get their points across. A study by Albert Mehrabian in 1971 concluded that face-to-face communication consists of words, tone of voice and body language, with the latter playing the most important role in the process.
Since the study was released, Mehrabian has amended the percentage importance he ascribed to each element. Nonetheless, it’s reasonable to say that telemedicine physicians—since only their heads and shoulders appear on the video screen in the Emergency Department (ED) or patient room—must make adjustments to the way they communicate, using voice, manner and facial expression to compensate for the fact that a key conversational element is constrained here.
The technology platforms our doctors use enable them to tilt the screen from their remote location so they can actually look at each participant in a conversation. It is vitally important to enhance communication in this manner. A positive, productive conversation begins with direct eye contact.
Telemedicine doctors also must be active listeners, letting the patient or family member take the time to ask questions, asking follow-up questions if necessary, and letting the patient or family member know they have been heard and understood. They should have the ability both verbally and with a headshot to be able to communicate in a way that shows that, across the miles and across the screen, that they care.
This is why in-person interviews aren’t always the best way to gauge a candidate interviewing for a position as a telemedicine physician. At Eagle, we also like to have a meeting with candidates via Skype or to see them on video so we can evaluate how well they come across onscreen.
2. Adaptability: Working across different platforms
Since telemedicine is still fairly new to inpatient care, most hospital technology platforms have been built without telemedicine in mind. That means there are multiple platforms and multiple Electronic Medical Records (EMR) or Electronic Health Records (EHR) systems—which set the structure of a patient examination—in use from hospital to hospital. Telemedicine physicians must be able to use them all.
With approximately 500 vendors selling EMR and EHR systems, it’s easy to be overwhelmed with the varying requirements of each system. Log ins are different. Some systems are more intuitive than others. Order sets and workflows differ. Telemedicine physicians must be prepared for all of them and, especially, must have a deep understanding of the EMRs in use by the hospitals in which they practice. They must be quick learners.
To help, Eagle has developed resources that are available on its physicians’ desktops, providing tools, guidance and summaries of the requirements of the particular EMR or EHR system in use. Other tools guide physicians through a hospital’s unique processes that must be adhered to.
Along with the technological differences come differences in skills and work styles from one clinical team to another. Telemedicine physicians, who might provide coverage at as many as 12 locations, must be able to learn and adapt to them all.
It might be that the main point of contact at the hospital location is a nurse practitioner (NP) with responsibility for managing clinical teams at night. It might be a physician in a busy emergency department (ED) who needs a physician who is authorized to admit a patient to the hospital. Or it might be an ICU nurse who needs an intensivist’s expertise on weekends when onsite intensivists are off-shift. Whatever the environment or work culture, the telemedicine physician must be able to understand the clinical team’s strengths and capabilities to collaborate effectively with them.
There might be cultural differences, too, between a small rural hospital in Kansas and a large suburban hospital outside Atlanta, for example. Good telemedicine in rural areas requires physicians that have the skills to adapt, as well.
3. Empathy: The most important quality of all
Good telemedicine physicians should have post-residency experience that includes working in a hospital that is not associated with an academic institution. We feel it is essential not only for the clinical experience but also for the real-life experience interacting with patients and their families outside the realm of the academic medical center, where specialists and resources are typically in abundant supply.
We find the experience helps physicians learn to be more resourceful, to adjust to more limited available resources, and with clinical teams that have varied skills and strengths. It’s an “in-the trenches” experience that also helps physicians develop empathy for patients and staff members from all walks of life. It facilitates an understanding of the challenges many hospitals face today, and how telemedicine—when done well—can solve them.
Skeptics might ask, “How can you teach someone to be empathetic?” It’s interesting to note that the experts say empathy doesn’t stop developing in childhood but is something that can be nurtured throughout our lives. Roman Krznaric, Ph.D., an author and noted adviser on empathy to organizations including Oxfam and the United Nations, writes that “trying another person’s life” is a good way to expand one’s empathy, and working in a variety of hospitals is one way of doing that.
He also says that empathetic people have a natural curiosity about strangers, listen hard, aren’t afraid to show vulnerability, and are continually looking to discover commonalities in the people they interact with. These are all qualities one should look for when considering candidates for telemedicine positions; they are clues to how the physician will interact on the job with patients, staff and families.
In telemedicine, there are no second chances
Because telemedicine is still relatively new to many people, a bad first encounter with a telemedicine physician can lead to patients, families and staff giving the entire program a negative mark. This is one of the reasons that it is critical for telemedicine physicians to possess qualities that will guarantee a good experience on that first encounter, and each encounter thereafter. Telemedicine’s success depends on it.