Do you ‘speak’ telehealth?

In the virtual world, a strong patient-provider relationship is built on good communication skills.

Learn more about our top communication strategies to improve virtual connection with patients.

When it comes to building a strong relationship between health provider and patient, good communication skills matter.

Health providers require nuanced skills of observation, active listening, questioning and empathy to elicit and share important health information and to foster a sense of rapport with patients.

So, what happens to patient-provider communication when consultations occur virtually?

In the virtual world, good communication skills – both verbal and non-verbal – are even more important.

Virtual care relies on providers utilising advanced communications skills to compensate – in part – for the loss of visual cues inherent in person-to-person consultations.

Visual cues are important because they provide insight into a patient’s mental, emotional, and behavioural state and can indicate patient misunderstanding and frustration as well as other important reactions.

Let’s take a closer look at some of the strategies that will strengthen your virtual communication skills.

Seeing eye to eye

In a virtual consultation, eye contact is an important non-verbal tool that promotes communication and connection between provider and patient. Read the full paper.

Eye contact enhances feelings of trust, understanding, empathy, and emotional connection and also helps create a more intimate setting.

To maximise eye contact during a virtual call, participants should position themselves in the centre of the screen, with the camera framing the top third of the trunk.

During the first minutes of a consultation, to help put the patient at ease, the provider can focus their gaze on the webcam, allowing the patient to discreetly assess them.

During the consultation, providers should aim for regular, brief eye contact with the patient. If the provider does need to look away from the screen – eg to take notes or check a second screen – they should explain what they are doing and why.

Be an active listener

According to the Australian College of Nursing, active listening is a way of listening and responding to a patient that shows the patient their message is both received and understood.

Active listening involves five elements:

Paying attention: Look at the patient directly, promote understanding by clarifying what the patient has said, rephrase highlights and key points.

Show that you’re listening: Use body language to show you are engaged – nod, smile, use hand gestures, ensure your posture is open, use small verbal cues to encourage the speaker to continue.

Feedback: Providing feedback to the patient shows you have understood their sentiments and allows you to empathise. Feedback also provides patients with an opportunity to correct any misconceptions.

Summarising: Summarise what the patient has said, giving the patient time to correct or add to, if required.

Defer judgement/respond appropriately: Rather than interrupting a patient, allow them to finish each point before asking questions; avoid interrupting with counter arguments. Foster a sense of respect and understanding, be mindful of your tone of voice and attitude, assert opinions respectively.

Pause and effect

One of the most effective ways to build rapport with a patient, is for a clinician to slow down their pace of speech and take time to pause.

Pausing regularly allows patients to contribute to the conversation and divulge important details that can aid diagnosis.

Aim for regular 3-5 second pauses; pausing for this amount of time might feel uncomfortable at first, but with practise, it will become second nature.

Focusing on speech clarity is also useful: a 2021 study found that clarity and communication can be improved by using inserted headphones instead of loudspeakers.

Signposting

This structuring skill helps patients understand the direction and structure of the consultation.

At the start of the appointment, explicitly tell the patient what is going to happen: e.g., ‘During this 20-minute consultation, first I will examine your ears, and then we can talk about how to treat the problem’.

Signposting is also a useful way to engage the patient and to ask permission, for example ‘Is it okay if I ask you some questions about your diet?’.

It is also helpful to ask the patient the main points they would like to discuss during the consultation. That way, issues can be prioritised, rather than having a patient share their most pressing concern at the end of the appointment.

Formative summaries

Another structuring skill, formative summaries involve a clinician gathering a chunk of information during a consultation, and regularly checking that it is correct by repeating the information back to the patient.

This shows the patient that a) you’ve heard them and b) you’ve got accurate information; it also empowers the patient to correct you. For example, ‘I’d like to recap, please correct me if I get anything wrong’.

Teach-back method

During a consultation, it is vital that patients understand and retain important health information for optimum treatment and recovery outcomes.

Unfortunately, an estimated 40-80% of all information is forgotten or misremembered by patients immediately after a consultation. Read more here.

Immediate and long-term recall following a telehealth consultation via telephone can be even more challenging: A recent study attributes this to the “listening effort” required for phone calls.

However, the study also suggests that telehealth via video conferencing could enhance comprehension and that the best way to mitigate listening effort, is to use techniques that boost a patient’s immediate recall.

One of the most effective – and simple – techniques that healthcare providers can use to promote patient recall, is the teach-back method.

The teach-back method requires health providers to simply ask patients to explain what they have just told them, using their own words.

Teach-back should be used whenever important concepts are explained including medicines, home-care instructions, the use of a new device, and the next steps in a patient’s care.

Consider your questions

When it comes to asking a patient about their health, slow down.

Stacking questions or asking compound questions can result in patients missing important facets of the question, and the provider can find at the conclusion of the consultation, some of the questions went unanswered.

Instead, ask short, open questions, then pause so the patient can respond.

Empathy for all

Despite the remote nature of virtual consultations, it is still possible for providers to convey empathy.

To boost empathy levels, take time to address a patient’s psycho-social concerns and use active listening to genuinely hear what patients are saying.

If a patient shares an important life problem or event with you, take the time to acknowledge the situation (“I’m sorry to hear that”) and validate their feelings (“That must be painful”).