Article Figures & Data
Tables
- Table 1
Particular Ways Relationship Might Manifest in Different Kinds of Health Care Encounters
Visit Type (Ordered Roughly From Least to More Relationship Oriented) Examples of How Relationship Might Particularly Manifest Telehealth Easy access Full attention to patient via the screen, or allowing no visual if that’s what the patient wants Urgent care Focusing carefully on a single problem and arranging helpful follow-up Being conveniently accessible in person Emergency department Getting a lot of technical services and consultation in 1 stop Arranging careful follow-up Acute illness visit to usual source of care Using longitudinal knowledge to contextualize and integrate care Using the visit to check in on other ongoing care Procedural visit to usual source of care Being sure the procedure still needs to be done and is congruent with the patient’s values Doing a good job with the procedure and considering follow-up options Subspecialist visit Providing expertise in the disease of focus Considering the disease in the context of the patient’s other illnesses, ongoing care, and life goals Chronic disease management Consider the illness context as well as the disease Identifying personal, interpersonal, or community strengths to help patient follow up on disease-management plans Well-care visit Identifying personal, interpersonal, or community strengths to help patient follow up on health-promotion plans Identify and connect to teachable moments Mental health visit Focus on confidentiality Taking a life course or developmental perspective Integrative care of people with multiple complex medical and/or social needs Looking for synergies in causes and treatments across problems Emphasizing contextual factors - Table 2
A Partial List of Ways to Invest in Relationship During Telehealth Encounters (That We Realized Might be Widely Applicable During Many Kinds of Visits)
Respecting patient’s need for easy access Multimodal methods of communication Respecting my need for easy access—timing Starting where people are Considering cost and patient’s ability to pay Virtual presence-focused attention even if physically remote Offer options to customize communication, such as being seen or just hearing Look for ways to help the patient feel understood and heard, such as summarizing Listening carefully to the patient’s experience Bringing any available background knowledge of the specific patient situation Questions that are on point, appropriate to the situation and visit type Getting to what is important Showing expertise, getting to the bottom of things builds trust Showing a receptive, not rushed, tone Providing contingency plans and options relevant to the patient’s situation Offering non-medical treatment options (eg, food, activities) Treating the patient as an individual, not just working through a protocol Asking for context Asking open-ended questions Feeling empathy Attending to emotions Not blaming Offer multiple treatment options, things to try, and a path forward Offering hope Find something the patient has done right and praising it Explaining in easy language Asking, “Is there anything else?” Finding out why this matters to me now and how Normalizing the patient’s experience when possible Working to get on the same page—doctor and patient Taking what we can learn from good call-centers and customer service industries Systems that empower the clinician and patient with time and a full range of options Power sharing. Being non-judgmental Explicitly acknowledging time limitations and then prioritizing based on attending to both what the patient feels is important and what is important from a biopsychosocial perspective Tying it together for the person—being understood Working to get to a shared goal If both patient and clinician feel connection after the visit, they bring something positive to the next encounter—building a community of expectations
Additional Files
The Article in Brief
Physical Distancing With Social Connectedness
Kurt C. Stange, and colleagues
Background Relationships between patients and clinicians matter, even in telehealth visits. A new article explores how clinicians can invest in relationships during a variety of visit types, from short-term telehealth, urgent care, and emergency department visits to ongoing visits for well care and chronic disease management.
What This Study Found In a telehealth visit, for example, clinicians can invest in the relationship by giving "full attention to the patient via the screen, or allowing no visual if that�s what the patient wants." In a more in-depth chronic disease management visit, clinicians can consider the illness context and the patient's life story in order to help the patient identify personal and community resources for managing their condition. As patients are more often treated by health care teams, and with the emergence of telemedicine, virtual visits are becoming more common--often with health care providers who do not know the patient or their health history. The authors conclude, "what we need in a pandemic is not social distancing, but physical distancing with social connectedness."
Implications
- Investing in relationships in all types of visits can personalize the experience for both patients and clinicians and may also result in more efficient, less costly care.
