Telehealth shows promise for fostering better doc-patient relationships
As telehealth use continues to expand, many are wondering what the ramifications will be when, as is widely expected, virtual care becomes a much larger part of the healthcare experience going forward.
A new study published in Mayo Clinic Proceedings suggests that patients might be much more willing to engage substantially with telehealth – and may find the experience much more rewarding – than many might have assumed even a few months ago.
The peer-reviewed study was led by Dr. Tania Elliott of NYU Langone Health and coauthored with Dr. Beth A. Lown of the Schwartz Center for Compassionate Healthcare and Arwen Sheridan and Ian Tong of telehealth company Doctor on Demand.
It suggests that Doctor on Demand’s video-based visits are often leading to rewarding relationships between patients and physicians and to improved patient satisfaction.
Researchers found that a majority of patients commented favorably on the "interpersonal connection and relationship-building aspects" of Doctor on Demand virtual visits. Many specifically mentioned the value of "building rapport" with their physicians, even when the encounter was mediated by a screen.
For the study, the researchers sought a qualitative assessment of patient-visit feedback after virtual visits. Researchers analyzed 4,572 comments from a random sample of nearly 50,000 comments that were rated five out of five stars by patients after their video telemedicine visit.
They then developed a final set of codes, with patient assessments specifying their thoughts about what the telehealth visit has helped accomplish: (1) builds rapport; (2) patient perspective; (3) expectation and agenda setting; (4) elicits information; (5) listens, is attentive; (6) shares information/provides guidance; (7) shares decision-making; (8) spent right Amount of time; (9) user experience; (10) uncodable; and (11) provided treatment.
"In many cases, patients actually said, 'Why can't primary care be like this?' And I didn't expect that."
Dr. Ian Tong, Doctor on Demand
More than 30% of the patient comments coded were classified as "building rapport," with the next highest-frequency code "shares information/provides guidance." The third most frequently cited was “user experience."
A basic, matter-of-fact assessment like "provided treatment," meanwhile, was listed just 2% of the time.
"These results suggest that patients who are satisfied with telemedicine encounters appreciate their relational experiences with the clinician and overall user experience, including access and convenience," said Elliott, et al., in the Mayo report.
"Highly satisfied patients who interacted with providers on this platform commented on key aspects of medical communication, particularly skills that demonstrate patient-centered relationship-building. This supports the notion that clinician-patient relationships can be established in a video-first model, without a previous in-person encounter, and that positive ratings do not seem to be focused solely on prescription receipt."
In an interview with Healthcare IT News, Doctor on Demand Chief Medical Officer Dr. Ian Tong said the results of the patient survey were something of a surprise.
"This was not an expected insight into why people like virtual care," he said. "In many cases, patients actually said, 'Why can't primary care be like this?' And I didn't expect that."
Tong's first experience of telehealth was years ago, "in the VA, around 2008," he said. "And it was always seen then as kind of a compromise – that people may not get as much out of the relationship. But I think this study actually calls some of that into question. When you code the kinds of things that people choose to comment on, without being prompted, and you see this feedback, that the comments were mostly about rapport building and the relationship."
Tong began his career as a "bedside medical doctor," he said. "I taught bedside medicine to students at Stanford. I myself entered (telehealth) with the assumption that we're probably compromising the relationship part. And I think this argues against that."
Perhaps one reason for patients' satisfaction with virtual visits is that, unlike in an exam room, where physicians must spend significant time during the encounter with their backs turned, documenting in the electronic health record, with telehealth visits, the conversation is face-to-face – even with a smartphone or tablet screen in between.
"You actually get eye contact," said Tong. "It's not just voice, but also to be able to see the doctor – eye contact, and having the camera located close to eye-height."
He also noted another Doctor on Demand data point that's not mentioned in the recent study.
"Our average visit length is about half the length of an office visit," he said. "So we spent less time with you and you're still commenting (positively) on the relationship. Whereas if you come into the office, patients often complain about the doctor not spending enough time with them."
Going forward, Tong does see telehealth having substantially more staying power than it did pre-pandemic – and thinks studies like this one, focused on patient experience, show why.
"I think it's the only way that it actually makes sense for our healthcare system to deliver value and quality at the scale of which we need it across the entire country," he said. "I bought it seven years ago, thinking this just makes sense, and this is how it is going to have to be done if we're going to achieve these goals."
And rather than being a subpar substitute, born of convenience and necessity, virtual care has huge potential to be something real and rewarding – perhaps even with some advantages that in-person encounters don't have, he said.
"It's not just convenience," said Tong. "There's more on the value side of that equation. There's quality, there's strong relationships and I think the practices that are delivering that through video-first encounters are going to rise to the top."