When a Video Visit Leads to Real Connection

Derick Alison
Derick Alison
9 Min Read

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    Fred Pelzman of Weill Cornell Internal Medicine Associates and weekly blogger for MedPage Today, follows what’s going on in the world of primary care medicine from the perspective of his own practice.

Sometimes a video visit is just a video visit.

And sometimes it’s a lot more than that.

Sometimes, a video visit ends up being pretty bland, neither party really gets into the groove, there’s no real connection, maybe some brief exchange of pleasantries and some banal information going back and forth.

Sort of like some office visits.

But sometimes it feels like it’s really worth it, that you can and did make a difference, that both the doctor and the patient really feel like something was accomplished. It feels like the timing has to be right, and the reasons for the visit have to be right.

Occasionally, I’ve had video visits on my schedule, and when the connection comes on, we sort of stare at each other, not really sure how to handle this interaction, and then slowly but surely we try to get to the agenda that each of us brings to the visit.

Have you been checking your blood pressure at home? How’s your blood pressure doing? How is the new medicine doing, any side effects?

Sometimes it turns out they’ve never even picked up the new prescription, and haven’t bought the home blood pressure monitor, and certainly haven’t been checking their blood pressure at home on the new (or old) regimen.

Maybe there’s something to gain there, maybe an opportunity to reinforce how important this new medication is, how important it is to take it every day, how useful checking your blood pressure at home can be.

But sometimes we both probably leave the visit with sort of a flat taste in our mouth, nothing much to see here.

I’ve even had situations where patients have said they are not really sure why we’re having the video visit. “Did you want me to schedule it, or did I?”

This has occasionally happened with hospital discharge visits, when the discharging team had made the patient an appointment to see me within a few days of discharge, and when we finally connected (after they’d converted it to a video visit since they didn’t want to bother coming all the way back to the hospital), they said nothing much had changed, they were really just still tired out from the admission, they were doing okay with the new medicine or the antibiotic or healing up after their surgery, but nothing much new to add.

Sure, I can reinforce a lot of stuff around what led to them being hospitalized, explore what they think might have happened, the good, the bad, and the ugly of the admission, and make sure they’re continuing to head in the right direction.

One time many years ago a patient fell and broke their shoulder, went to the emergency room, was put in a sling and given pain medication, and told they needed to see me within 1 to 2 days for a follow-up appointment.

The patient scheduled a video visit, and I got to look at them sitting there with their arm in a sling, and they got to tell me how little pain they had (in fact they had never even taken a single one of the tablets, felt they didn’t need it).

So, probably overall, a visit that didn’t have much added value.

But I think as we continue to build out telehealth and video visits into our armamentarium, there are great opportunities to craft a really useful type of visit to make a lot of difference for our patients, and save them a lot of time and travel. Following up on a new medication, following up on a mental health issue, continuing a discussion about a topic they wanted to raise that they never really got to during an office visit.

We could also potentially build out team video visits, where I would see the patient in the office, then additional members of the team could schedule follow-up appointments — nurses to go over medicines and home monitoring, pharmacists to do dose escalation, social workers to connect people to the resources in their community they need to manage the health condition that we had been addressing.

Social workers, care coordinators, and care managers may be able to take a virtual walk around the home, assessing the home environment, adequacy of food, fall risks such as poor lighting and loose carpeting, all from the comfort of their offices.

Getting a peek into the homes of our patients is an added dimension to the privilege they have already granted to us by entering into the doctor-patient relationship, telling us many things that they tell few others, and letting us examine and test them in ways no one else does.

Now we can see their home, how they live, new data that can shed more light on who they are and how they make it through the world every day. (Although many probably straighten up the room before they connect.)

Making sure that everyone knows what the agenda is, that we’re all on the same page, that there’s a really good reason for this visit, seems to make a lot of sense.

Sometimes we discover this agenda in the notes that the schedulers pop into the electronic medical record. Pre-op visit. Wants to be tested for COVID-19. Worsening back pain. Dizziness.

Sometimes we only discover the agenda, the true agenda, once things get started, once the connection is made.

Adding on additional tools, such as remote patient monitoring, can be really powerful, can extend the care we provide far beyond the confines of our 20-minute office visit — home blood pressure monitoring, home weight trends, pulse oximetry, results of continuous glucose monitoring, and more.

Eventually large and small datasets that our patients collect on themselves at home — activity trackers, gait steadiness, calorie counts, medication compliance — will become available for us, and hopefully we’ll learn how to incorporate these into the systems we use, to synthesize them to help us get our patients to a better state of health.

Maybe sometime off in the future, our video visits will include enough virtual reality and haptics that we’ll be able to truly effectively examine our patients.

Someday, they’ll be able to hold their smartphones or some other similar device up to their chest to let us listen to their heart and lungs, look in their ears, take a virtual swab of their throat.

The possibilities are endless. Think about it — a virtual colonoscopy over video?

We’re nowhere near there yet, but I think as long as we continue to think creatively, to expand the way we use these new tools, and to keep on getting support from the insurance companies and other healthcare institutions to help us innovate and improve and bring more care into the lives and homes of our patients, things are likely to only get better.

We’ll just see.

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