Enhancing Patient Relations with Virtual Care
By Danesh Mazloomdoost, MD
I’m a squishy kind of doctor who really values my connection with patients. Our field demands it – very few obstacles in life challenge one’s sense of self more than having to adjust to a physical limitation. Physical pain inevitably manifests emotionally vice versa. So the concept of a fulfilling healthcare model delivered remotely through a digital screen and telecom waves seems counterintuitive to touchy-feely doctors. It’s not. Used correctly, remote patient care will enhance the patient-doctor relationship in surprising yet foreseeable ways.
The pandemic’s disruption in continuity of care has forced many offices to radically change their processes. In an environment of healthcare burnout, inundated with insurance and bureaucratic challenges, any major challenge is a daunting but it also forces us to reexamine processes we take for granted and re-envision the future we hope to see. It forced my entire office into a deconstructive mindset, challenging every norm and questioning our workflows to sieve the value-adds from the bureaucratic templates.
We gradually came to a realization that the intimacy of a care-taker and receiver relationship is not dictated by proximity, but by understanding. Relating on a much more personal level, appreciating a patient’s state of being on two planes – the tangible plane of actions and decisions, the intangible plane of emotions and responses. In the hustle and bustle of a clinical day, contextualizing the patient is very difficult. The intangible plane becomes much more real when connected through a video feed into the patient’s home and comfort zone. Colored by the ambience of noises, decor, or family, the bond we all seek with the patients gains many more contextual anchors. “I see pictures of a fishing trip…crochet on the walls…a pet cat.” Affirming these observations with the patient yields far more trust in the relationship than the out of context engagements of a clinical space.
It is difficult to create continuity when our only tool is a staccato of clinical visits. These spaced intervals are further limited by reliance on the patient to present problems to their provider. It has evolved a relationship in which our clinical role is only that of a healer of disease rather than the caretaker of health. Under the conventional model, we have a blurry lens into our patients’ lives shaped by second-hand observations through the patient’s eyes. This rarely presents the opportunities to identify problems before it is noticed by the patient. With remote patient care, however, integration into patient’s lives in a meaningful trusting way can help reshape our role yielding a more proactive, integrated, and engaged relationship.
Diet, exercise, and behavior changes are often confirmed to have as much if not greater impact on disease outcomes than the pharmaceutical or medical intervention. Every clinician knows the impact of smoking, glycemic index, and physical activity on cardiovascular or diabetic health outcomes. Influencing these variables however have often been an obstacle in healthcare. The expense of both inpatient and outpatient rehabilitative services can be a prohibiting factor and limit the impact given its clinical context. Telehealth and remote patient engagement tools offer an entirely new avenue to facilitate behavior changes.
I long ago started imagining the future of healthcare, so prior to the onset of Covid, I started consulting for an innovative health tech startup in England called Huma. It was full of innovative ideas on how to rethink healthcare using remote technologies. For instance, they had a division developing applications using wearables to collect data and aggregate new insights into health that are otherwise inaccessible. These new digital biometrics will help drive predictive healthcare that safeguards health rather than just relying on presentation of disease to offer treatment.
In our clinic, for instance, we have implemented a chronic care management (CCM) pathway to better integrate day-to-day communications with patients. Through text messaging, a medium for two-way communications allows for nearly daily engagement. Our clinical philosophy is that chronic pain is chronic injury which is heavily influenced by lifestyle choices that either promote repair or hinder it. Educating a patient on what they should do is fruitless without guidance on how they should do it and using CCM we are fostering the integration needed to coach the necessary change.
We are further developing a remote patient monitoring program to enhance our visibility of how patients move in their daily routine while engaging patient accountability. With the continuity and plethora of data points available, patterns can emerge that would otherwise be invisible in periodic clinical engagement. It creates new insights into our patients functionality and helps guide interventions and coaching with great implications.
The landscape of medicine is priming for this transition. Clinicians may be unaware of the breadth of new CPT codes that enable greater integration into patient’s lives. It’s not just about the technology, it’s also about the logistics of care, and this toolbox of reimbursement opportunities can help innovative doctors deconstruct and reshape their fields.
We have all experienced the craving for physical connection during this pandemic. Comforting someone through hardship is not the same without offering a tissue or holding a hand. Nonetheless, by now we have all started to envision the near future of somewhat “return to normal.” Now is the time to start thinking about the hybrid healthcare system of the future. One in which we can integrate the best of both worlds – face-to-face clinical encounters and remote patient engagements. It’s a call to all physicians and healthcare leaders to deconstruct our variables of care and identify the value-adds; to imagine without bureaucratic constraints; to herald unforeseen opportunities and set forth plans that healthcare administrators will find too compelling to decline.
(This article was first published in MD-Update, #132; February 2021. See www.md-update.com.)