Communicating to Patients

1. Avoiding Technical or Medical Terminology

When communicating with patients, you should:

• Keep it simple.
• Be clear.
• Avoid the use of any confusing technical or medical terminology. If you have to use some advanced terminology, define it in simple, direct terms.
• Try to avoid using three-syllable words to decrease the reading level.
• Prepare handouts to be info-graphic and at no more than a 5th-grade reading level, similar to what you would do with an informed consent form.
• Provide it in multiple languages and also in a video format.

Health information should have the following characteristics.

Health Information Characteristic	Description
Accurate	Using health literacy best practices does not mean “dumbing down” the information or distorting the science. Health literacy practices ensure patient information is accurate AND delivered in ways people can understand it.
Accessible	Just because you create health information doesn’t mean people will see it or use it. Information needs to readily accessible for it to be used. Here are some things to consider: Is the information where people can see it? How are people who are not actively seeking the information being exposed to it? Do you have a main message statement? Have you made the information easy to scan and skim using large font, sub-heads and bullets, pictures, and white space? Do the images match the text and have useful captions? Keep in mind the web is not always the best way to reach the general public. Multiple channels and formats are the best, and it is your responsibility to make sure it reaches the public in a usable format.
Actionable	It is natural to want to tell people everything we know on a subject, but that isn’t necessarily helpful. In the healthcare field, we want to call people to action, usually to start or stop doing something or do more or less of something. Therefore, limit background information, and make sure you provide actionable information so the people you reach CAN do something with the information. For example, educate people on cancer screening and implore them to call today for an appointment at the following number.
See the Center for Disease Control for more information on Health Literacy.

term to know

Informed Consent

The process in healthcare where a patient voluntarily provides permission to undergo care following a full explanation on the risks, benefits, and alternatives.

hint

Refer to the Telehealth: Rules and Risk Management course for more information on informed consent.

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2. Identifying Technological Needs and Equipment Requirements

It is important to clearly identify what equipment the patient will need to participate in telehealth. You should also identify what kind of internet connection will be needed and explain that synchronous visits will need to have both audio and visual capabilities.

hint

Refer to the Telehealth: Technical Requirements course for more information.

When preparing an optimal environment for delivering virtual care, you should:

• Choose a well-lit area with a strong, secure internet connection.
• Choose a private, confidential space.
• Ensure there is no background noise and device notifications are silenced.
• Use a high-definition webcam and microphone (American Academy of Physicians, 2020).

It is critical to the success of your telehealth services to provide the same level of support for video and audio visits that you do for in-person visits. The best way to prevent technology problems on the day of the appointment is to conduct a pre-visit technology check-in with the patient 24 hours prior to the visit for all new patients, and as an option for all patients. The pre-visit technology check is also an opportunity to assist the patient with completing pre-visit questionnaires, gather feedback on what they expect from the visit, update their insurance, and complete other required tasks.

On the day of the telehealth visit, a medical assistant (MA) can room the patient 15-30 minutes prior to the visit by logging on, greeting the patient, describing what to expect, and confirming information in the same manner as an in-person visit. If the patient does not arrive during the 15-minute period, the MA can call the patient and assist with connection, if needed.

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3. Improving Webside Manner

Studies show that most patients feel the quality of the care provided in a virtual visit is as good as, if not better than, an in-person visit, but that sentiment can be quickly lost if the technology does not work smoothly. Therefore, think of your “webside manner” as your digital version of the bedside manner by building rapport with your patient that is thoughtful of the technology that you and the patient are using.

American Academy of Family Practitioners (2020) outlines the following best practices to have an excellent webside manner:

Preparation

• Ensure that you are in a private space that is appropriate for a HIPAA-compliant conversation.
• Test your internet connection to ensure that speeds are appropriate to support a well-working video feed.
• Set up your workspace so that you are front-lit, the camera view covers approximately your head and shoulders, and the camera is at eye height. You should seem to be looking neither up at, nor down to, the patient.
• Make sure the patient can see your face. Having a window or light behind you can make the camera darken your face so the patient cannot see your facial features.
• Make sure the background is uncluttered and not distracting, and that you are dressed professionally.
• Review patient complaints and records before beginning the visit.

During the Visit

• Be sure to communicate instructions to the patient on what to do if the connection is lost and you cannot reconnect (e.g., you might tell them that you will call the patient and continue the visit over the telephone).
• Demonstrate comfort with and confidence in the technology (regardless of how you are feeling about it) to help patients feel at ease and focus on their care instead of the virtual modality.
• Remember that the patient cannot see what you are doing offscreen and may feel you are being inattentive if you look away from the camera. To help the patient feel comfortable, narrate actions or even ask permission if you are working offscreen (“Is it OK if I type while you are talking? I want to make sure that I am recording all of the important information you are saying.”)
  • Speak clearly and deliberately.
  • Pause to allow for transmission delay.
  • Listen carefully to the patient. Let the patient know you are listening by providing cues such as nodding your head and saying things such as “I see.”
  • Express empathy by practicing the S.A.V.E. method (below):
    • Support or partnership statements
    • Acknowledge the situation
    • Validate the patient’s feelings or experience
    • Name their emotion
• Verbalize and collaboratively determine next steps, such as follow-up appointments, care plans, or prescription orders.
• Express gratitude for their engagement in the visit.
• Invite the patient to end the encounter. Many patients appreciate the feeling of autonomy that gives, and it also allows the patient to determine whether they have any final questions or concerns.

After the Visit

• Share the post-visit summary and action plan.
• Assist with scheduling referrals: If a patient needs to see a specialist, make sure your scheduling team provides a warm handoff by assisting with scheduling the visit or at least providing the specialist’s contact information and the referral. Your practice may check in on a weekly basis with the patient to make sure they saw the specialist.

Audio-only visits are more challenging since you cannot see facial expressions or body language. Here are some tips to make the audio visit more productive and meaningful.

• Smile when you greet a patient on the telephone (research shows that people can tell by the tone of your voice if you are smiling).
• Reflect on something you admire about the patient.
• Elicit reactions overtly (e.g., “What do you think about that?”).
• Use empathic statements to make up for the lack of visual cues.

For patients whose first language is not English, telephonic interpreter services can be integrated into telehealth encounters as long as your practice ensures that the interpreter service has access to your telehealth platform or can call in through a conference line.

Authored by Cindy Ebner, MSN, RN, CPHRM, FASHRM and Melissa A. Singer Pressman, PhD, MLIS

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Support

If you are struggling with a concept or terminology in the course, you may contact TelehealthSupport@capella.edu for assistance.

If you are having technical issues, please contact learningcoach@sophia.org.