Conducting Appointments Via Phone Call
Provider and Staff Telehealth GuideVideo and phone visits have ample potential for successful interactions with patients. To arm you with the tools you need to have a successful video visit, we’ve created an evidence-based guide outlining best practices for telehealth visits by sub-specialty.ContentsConducting Appointments Via Phone CallConducting Appointments Via Video CallLocation and SetupUsing Video SoftwarePreparing the PatientInteracting with the PatientPhysical ExaminationsDental TelehealthPediatric TelehealthNeurology TelehealthPain Clinic TelehealthPhysical and Occupational TherapyOrthopedic TelehealthBehavior Health TelehealthConducting Appointments Via Phone CallIt can be challenging to connect with your patient and communicate with them effectively when speaking to them over the phone. Follow these tips to ensure your patient feels listened to and cared for.When you begin the call, consider orienting the patient with your location (e.g “I’m speaking to you from my office”), and ensuring them that they will not be overheard..Use active listening – React vocally to what they are, ask clarifying questions, and do not be afraid to ask them to repeat. Maintain self-awareness throughout the call.Pay attention to the patients’ voice – changes in tone/pitch or verbal expression.If you need to take a moment to complete an action that does not involve speaking, such as taking notes or checking a chart, vocalize what you are doing.Repeat what you’ve heard back to the patient.Don’t let the phone call cause you to lose any emotional interactions you may normally have in face to face appointments - allow time for a social check in, ask how they are doing, etc.Conduct your phone calls in a quiet place with no distractions.Have patience with technical difficulties. You may need to repeat instructions to ensure they understand.Consider having the patient repeat instructions back to you to ensure they have heard you correctly. Summarize main points to ensure both provider and patient have clearly received all the information and instructions.Make sure to ask if they have additional thoughts or questions before ending the phone call.Wait for the patient to hang up first in case of outstanding comments or questions.Conducting Appointments Via Video CallLocation and SetupSelect a quiet location for the video call, preferably professional with few distractions such as paintings or windows. If you must have a window in the background, ensure the curtains are closed.When the call begins, orient the patient with where you are (“I am sitting in my office”), and assure the patient that you are alone.Use consistent lighting throughout the room.Ensure that your face is well lit. It should take up at most 1/3 of the screen.If possible, use a computer camera rather than a phone camera to minimize camera movement, which can be dizzying to patients.Turn off phone and computer notifications during appointments.Using Video SoftwareIf there are multiple people on the Zoom call, ask those not speaking to mute themselves.Be patient of technical difficulties. If needed, repeat information, or ask the patient to repeat themselves.Consider taking advantage of Zoom features such as screen share or the whiteboard feature to share test results or for explanations.If the patient is in a location where they do not have privacy, consider asking them to use the messaging feature of Zoom to share sensitive information.Preparing the PatientConsider asking the patient to bring items with them to the phone call such as a thermometer or flashlight.If your patient has difficulties with technology, suggest that they have a “technical liaison” to help set up meetings and be available in case of technical difficulties.Ask the patient to conduct the call in a private, well lit room if possible. Advise them to have a place to set the phone/computer camera down so that they can complete self-examinations.Interacting with the PatientKeep your eyes pointed at the camera so that your image is looking the patient in the eyes. If possible, full screen the image of the patient to avoid looking to one side of the screen.When using a video call, continue to use active listening skills that you would use in real life, including verbal responses, nodding, or gesturing.If you need to do something that involves taking your eyes away from the camera, such as taking notes or checking charts, inform the patient of what you are doing so that you do not appear to be distracted.Have patients hold medications up to the camera to check labels if needed.Consider having the patient repeat instructions back to you to ensure they have heard you correctly. Summarize main points to ensure both provider and patient have clearly received all the information and instructions.Make sure to ask if they have additional thoughts or questions before ending the phone call.Wait for the patient to hang up first in case of outstanding comments or questions.Don’t let the phone call cause you to lose any emotional interactions you may normally have in face to face appointments - allow time for a social check in, ask how they are doing, etc.Conduct your phone calls in a quiet place with no distractions.Physical ExaminationsBe aware of the patient’s environment, breathing, movements, and cognition.Ask patients to wash their hands before beginning examinations of sensitive areas.Consider if the patient should have a family member or care giver to help them through the examination if they have difficulties with moving.Guide your patients through a self-examination, with them telling you what they observe. For example, guide the patient through moving their fingers along their throat and describing what they observe to check thyroid.If needed, have the patients mimic your motions rather than just explaining. Have patients demonstrate their range of motion by guiding them through various movements and having them tell you when they experience pain or discomfort.To find precise locations of pain, have patients move their hands up and down the area of interest and to stop when they reach where the pain begins.If needed, ask patients to bring the area of interest closer to the camera.If needed, ask patients to repeat movements.A helpful video that show examples of guiding patients through examinations for a URI, back pain, and shoulder pain can be found here: TelehealthAsk patients to prepare supplies for the appointment ahead of time such as a flashlight.It may be easier in some cases to ask the patient to take a photo or have a family member take a photo of the area before the appointment and to use the share screen function.Advice the patient to have a family member or caregiver on hand to hold up a flashlight or the camera to the mouth.If the patient is a child, ask the parent to be present and to help with holding up the camera.Ask patients to wash hands before handling the inside of their mouth.If a family member is assisting, consider asking them to wear gloves and a mask before coming near the patients mouth, and to wash hands.Consider the use of visual aids via share screen, as well as the use of the “annotate” feature of screen sharing.Pediatric TelehealthConsider the age of the patient and what that might imply towards their experience with technology.Younger children may need help understanding that you can see them and they are seeing a live video of you. Consider using phrases such as, “Pretend the screen is a window between us, where I can see you and you can see me.”With younger children, movements may need to be exaggerated over video calls. Minimize distractions in your location and encourage parents to do the same.Parents may be needed to help with physical examinations for younger children, talking them through the motions rather than the child, and having them vocalize what they observe.When checking locations of pain and range of movement, consider if it is better for you or the parent to ask questions.Consider the age of the patient and what they might need for privacy.Older children may feel better having their appointment in a private place with headphones or using the messaging feature of Zoom for sensitive information. Parents can be asked to remain in a different room but be on hand in case they are needed as aid in physical examinations.Consider asking parents to write down a list of their child’s symptoms before the appointments, as well as information such as the child’s weight.For younger children, consider asking the parent to bring comfort items or activities.Ensure communication and active listening with both parent and child, listening and repeating both and asking both for outstanding thoughts or questions before ending the appointment.Neurology TelehealthConsider the symptoms of the patients and if they need a family member or caregiver with them in case of dizziness or to aid with physical examinations.Consider asking the patient to conduct their appointment via an open room with a camera that can pick up Be careful of bright lights in your background.Observe speech rate, volume, articulation, and thought process during conversations.Many aspects of neurological examinations can be completed via video calling, describing to the patient what to do and observing them, such as shoulder shrugging, pallet elevations, and head rotation.Montreal cognitive assessments and mini-mental state examinations are both possible through video call and screen sharing.Holding up photos and sentences and or using screen sharing with the patient full screening your image are both useful ways to test range of sight.Another method can be to imagine dividing the screen into four parts and holding up an object or your hands in each part, asking the patient to describe what/if they can see.Observe pupil dilation and contraction by having the patient bring their eyes close to the camera, potentially also using a flashlight.Pronator drifts, squats, and satellite signs can all be used to assess strength.Ice cubes can be used to test temperature sensitivity by having the patient holding it against their skin in various areas and comparing.Family members can also be used to test for numbness or for the finger rub test.Patients can bring red objects to test for red desaturation. Keep in mind that different screens/cameras can pick up colors in different ways so what your patient is seeing may be different from what you see on your screen.For more advice on neurological examinations via telehealth, view the video at this link: Clinic TelehealthTo determine locations of pain, have patients move their hands over areas until they reach where the pain starts. Have them repeat the process from the other direction. Do this horizontally and vertically as needed to determine the entire area of pain.Consider having a family member or caregiver attend the appointment to help with physical examinations in the case where the patient may have mobility issues.Physical and Occupational TherapyPatients and Providers should set up areas ahead of time to allow for movement, and to ensure that the camera can see them when they would be lying down, sitting, or standing up.If the camera camera cannot be set up to show all angles, plan out places to move the camera.Contact the patient ahead of time if possible, to ask what equipment they have available.Advise the patient to wear comfortable clothing that shows movement to make it easier for the provider to track how their body moves.Therapists may need to show movements and positions more times than usual to ensure the patient understands.Consider using screen share to show diagrams or examples of exercises or movements.To learn more about telehealth and physical therapy, the American Physical Therapy Association has a 2 hour course on teletherapy and it’s benefits and uses here: TelehealthConsider having a family member or caregiver attend the appointment to help with physical examinations in the case where the patient may have mobility issues or difficulty describing pain.Screen share can be useful for showing test results, consider using the annotate feature to explain results to patients.Behavior Health TelehealthPatients and providers should use a private space with a low noise level, no visual distractions, and consistent lighting. Keep windows and curtains closed and tell other household members to avoid disruptions.Orient patients with your location and to ensure you are alone for their comfort.If the patient does not privacy in their household, suggest headphones or the messaging feature of Zoom.If patients are self-conscious of seeing themselves on video, suggest taping a piece of paper over the part of their screen with their video on it.Patients should avoid completing tasks they would not normally do during an appointment, such as household chores.Patients should ask family members to avoid downloading large files over the internet to avoid technical interruptions.SourcesCalton, Brook, Nauzley Abedini, and Michael Fratkin. “Telemedicine in the Time of Coronavirus.” Journal of Pain and Symptom Management, March 31, 2020. . 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