Doing telemedicine is easier than working in a clinic. You have to figure out your own workflow and understand that your office skills don’t translate well to a telemedicine visit.
The income potential with telemedicine is high, the work is easier, and the acuity lower. In fact, there is less risk practicing telemedicine than traditional medicine. I have written multiple posts on the difference.
In this post I’ll discuss 10 telemedicine tricks you can use to get through patients faster, efficiently, and minimize your risk as a telehealth provider.
10 Telemedicine Tricks
Most of these tricks will apply to urgent care style telemedicine visits. The purpose of writing these 10 tricks is to make telemedicine a better experience for both the patient and the clinician.
It doesn’t matter if you’re an MD/DO or NP/PA. These tricks should make you better whenever you are performing a virtual visit with a patient.
1. Triage, Don’t Diagnose
In the urgent care we assume that a patient who leaves empty-handed will be unhappy. In a telemedicine visit the patient is often just looking for advice.
Triage the patient first and don’t waste time gathering information to help you manage a particular disease or come up with a medical-school-style differential diagnosis list.
Use symptoms as your diagnosis whenever possible. Remember that most medical boards will not let you off the hook if you didn’t do a physical exam on the patient. So use ‘dysuria’ instead of UTI and explain your reasoning in your MDM.
2. Keep it Short
Asking close ended questions is the key to telemedicine success. Make sure to repeat a brief synopsis back to the patient so that they feel heard but keep the patient on track.
Forget displays of fake empathy. Really listen to the patient and repeat to them the important things. Try to read their mind – what is it they are most worried about? ALS because they have a tingling tongue? Okay, good, now we know.
It’s generally safe to assume that the pertinent positives are included by the patient. Don’t go digging too hard for other symptoms. If the patient is a poor historian then you shouldn’t be managing them online.
3. Minimize Video Usage
A video visit throws both you and the patient off. Maintaining eye contact and watching their dog juggling in the background will distract you and keep you from writing your note while you’re talking to the patient.
Avoid doing a video visit if a telephone visit is possible. Technology is too far behind for us to get a good look at a rash or assess the overall appearance of a patient on video.
If you do a video visit, explain to the patient that you will be taking notes while they are talking. Switch to a different screen and start typing but continue looking at the camera – they will feel as though you are still looking at them but you won’t be distracted by their acrobatic pets.
4. Ask for Photos
Most telemedicine visits allow the patient to upload an image even after the visit has started. Ask for photos of the body part in question whenever possible.
A good photo can shortcut the entire process. An obvious gouty toe, a ringworm rash, a sprained ankle, or sprained finger are all sometimes easy to diagnose when combined with the history.
5. Verify the Pharmacy
You will prevent so many headaches if you take the time to verify not just the name but also the address of the particular pharmacy the patient wants to use.
If a person lives in Lebanon, Oregon then you’re probably fine – there will only be a couple of pharmacies by a particular name, if any pharmacies at all. But in Los Angeles there might be three CVS pharmacies just a few blocks from each other.
6. Use Google Documents
You can use Google Documents to type your note into. This will allow you to use the built-in and brilliant auto-correct.
But, far better, is the option of voice dictation with Google Docs. You can dictate the entire note at fast speeds and Google Docs will pick it up with minimal errors.
In my experience it gets better the more you use it.
7. Have a resource list
Have phone numbers and website addresses for various community resources. It might be free dental clinics, free community health clinics, or various laboratories.
I also have links saved for exercises which patients can do either from YouTube or from websites which have plenty of pictures.
Here are a few other things worth having links to which you can readily share with the patient:
- home remedy options for common diseases
- herbal or naturopathic websites
- list of your favorite supplements/herb brands
- ibuprofen/Tylenol dosing for children
- travel immunization resources
- disability resources
- home testing kits for various diseases, including STD’s
8. Walk through a pharmacy
Have your walked through your local pharmacy recently? There are all sorts of new stuff which pop up there regularly.
- Home test kits for Strep Throat and UTI and BV and Ketones
- Kits for ear wax removal and to treat brittle nails
- Acne remedies and all sorts of treatments for dandruff
- Shoe inserts and contraptions for all sorts of foot ailments
- Probiotics for every symptom under the sun
- Naturopathic or herbal or green or holy or whatever kind of ear drops for kids with ear pains
Learn them, write them down, and recommend them to your patients. You’ll come across as brilliant.
9. Don’t Say No
You don’t want to say no, you want to say ‘I am unable to’. I know they sound the same but using your own clever phrase instead of the common ‘no’ will make you less likely to butt heads with the patient.
“It wouldn’t be right for me to give you antibiotics for strep throat without doing a strep test.”
“Before antibiotics can be prescribed a clinician needs to look inside your child’s ear canal and visualize the eardrum.”
If all fails, blame the institution of medicine: “I’m not allowed to do x without y.”
10. Don’t Put Down a Colleague
Whether it’s another MD/DO or an NP/PA or even a nurse who made a certain suggestion to your patient that’s blatantly wrong, don’t put that healthcare provider down. You don’t know the context.
I’m not talking about karma. It just makes you look bad if you put down a colleague. Explain that you can’t comment on someone else’s work or opinion and that you can only act based on your own expertise.