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Initializing the call

Appointments that take place over phone or video have lot in common with face-to-face appointments, however, they also have some peculiarities that should be taken care of.

You will still initiate the consultation by calling or inviting the patient and you should start by saying something like: "Can you hear me?", "Can you see me?" to prompt patient to check and optimise the technical set-up.

Greeting

As soon as you realize the patient can hear you, “Thank you for inviting me in your home today” would be an easy start to begin the consultation. A simple acknowledgement that they have invited you into their home by using the technology can speak volumes about your willingness to understand the patient’s internal state. Research has shown that people can tell if you are smiling by the tone of your voice so, for patients you know, reflect upon something you admire about them before initiating the call. This will naturally make you smile when you greet the patient, warmly expressing that you are happy to have the chance to talk with the patient today, and contributing to lower many of the patient resistances or barriers.

Introduction

After the icebreaker, in particular when you meet a patient for the first time, it is recommended being a bit formal. All staff and everyone else in the room, even those off-camera, should introduce themselves. Take lot of care in introducing yourself and explain your role. Just as the physician wants to know all about the patient, the patient should know a lot about the physician as well. This improves engagement, making the patient feel more like a contributor to his or her health management.

Ask for consent

The patient shall also formally introduce herself and present an ID document for verification of date of birth and address. Then you shall ask the patient verbal consent for a virtual consultation and confirm they are alone. In case patient has assistants, verify their identity and clearly ask the patient the authorization and consent for them to be present. Take and record all those verbal consents. If you need to record the whole consultation, this is the right time to ask it to the patient. Check your organization guidelines for any extra consent may be necessary to get from the patient at this stage.

Reassurance

After the formal introduction, you shall explain how the virtual appointment will work and the allocated time. The more this point is clear, the higher the chances you will be able to follow the consultation plan and you will not exceed the time limit. Check for agreement with the patient about the meeting agenda, some patients require reassurance they are receiving the same level of care and consideration; older and vulnerable patients may need longer or more support. This is the time you can start bringing the consultation to a less formal, more personal tone, establishing that the visit is not all about numbers. As an example, you can address patients by their first names: a patient will feel more comfortable and more open if his or her first name is used.

Observation

Because of technological constraints, your capability to detect the body language will be strongly impaired during remote consultations, therefore you have to use your speech to demonstrate engagement and empathy, and you have to pay more attention and carefully listen to the patient tone and language to integrate the spoken words.

Full engagement

To demonstrate to the patient that you are engaged, you do not necessary need to look at the camera all time, but just inform the patient when you are otherwise occupied (e.g. while you are  taking notes or reading something on another screen). To show engagement it is also important to verbally acknowledge that you are listening. It may be more obvious in person, so phrases like “Tell me more about this” right after a patient describes a problem, can signal that you are fully engaged. 

Active listening

Patients are missing out on your nonverbal and facial expressions of care, so you need to convey these sentiments with your voice. Use active listening by verbally and overtly reflecting back to the patient their emotions and asking for confirmation. Statements like: “I hear concern in your voice, is that how you feel?” contribute to better connect with the patient and, whether they are correct or not, will push the patient to  give you more detailed information and feel as being active part and contributor to their care. Finally remember to give the patients a lot of opportunities to make questions. When you are giving recommendations, openly ask: “What do you think about that?”. 

Notes

During the consultation you will still need to capture notes and outcomes as they would be for a face-to-face appointment. This will allow you to clearly share an end of appointment summary, containing: 

  • The step by step summary of the consultation, with emphasis on the key moments. 
  • The agreed actions from the appointment, ensuring the patient (and assistant is present) understands these and any timescale.

Address questions

Before ending the appointment, check the patient’s preference for future contact. If they are happy to have a virtual consultation again and use email as a more efficient way of contacting, you can continue using virtual consultations as the ‘norm’. Finally remember to give the patient a chance to ask any final questions. 

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