How To Best Care For Your Patients When They Are Not Physically In Front Of You

Patients can bring someone to accompany them so make sure your patient is aware of this in case they want someone else present.

One of the consequences of the pandemic is the dramatic growth of Telehealth and Telemedicine. But how can doctors and providers best care for their patients when they are not physically in front of them? What do doctors wish patients knew in order to make sure they are getting the best results even though they are not actually in the office? How can Telehealth approximate and even improve upon the healthcare that traditional doctors’ visits can provide?


In this interview series, called “Telehealth Best Practices; How To Best Care For Your Patients When They Are Not Physically In Front Of You” we are talking to successful Doctors, Dentists, Psychotherapists, Counselors, and other medical and wellness professionals who share lessons and stories from their experience about the best practices in Telehealth. As a part of this series, I had the pleasure of interviewing Dr. Janice Johnston.

Since the pandemic began many healthcare providers have offered telehealth services in efforts to avoid unnecessary COVID-19 exposure to patients and providers. The benefits of telehealth have expanded beyond curbing COVID-19. Today many providers continue to offer telehealth because it is a quick and convenient way to assess patient’s needs, thus avoiding unnecessary waiting room times, taking time off work and driving across town. As Dr. David Berg, CEO of Redirect Health, says their approach is 24/7/365 virtual-first primary care and then in-office when the provider determines it is necessary.

Dr. Johnston has served as Chief Medical Officer and Co-founder since January 2013. She oversees all medical operations as well as patient experience, spearheading efforts to enhance quality of care while improving administrative efficiencies. Dr. Johnston is integral to both the telehealth and in-person clinical operations, continually advancing strategies to improve member service and ensure positive patient outcomes. She holds an M.D. from the University of Toronto and is currently a Health Insider for ABC15 in Phoenix. Ariz. Dr. David Berg is also a co-founder of Redirect Health. Prior to co-founding Redirect Health, Dr. Berg established and maintained successful healthcare clinics both in Canada and the United States. With Redirect Health he has leveraged his decades of healthcare leadership experience to make healthcare simple and affordable for businesses throughout the country. Dr. Berg is the author of The Business Owner’s Guide to Ending the Fight with Healthcare, a how-to guide that helps business owners leverage healthcare as a competitive advantage. In 2018, the Phoenix Business Journal honored Dr. Berg with the “Healthcare Heroes Innovator Award” for creating a transformative healthcare member experience that eliminates barriers for people to get affordable healthcare. He holds degrees in Physics and Biology from the University of Toronto as well as a Doctor of Chiropractic degree from The Canadian Memorial Chiropractic College.

Thank you so much for joining us in this interview series! Telehealth Best Practices: How to Care For Patients When They’re Not In Front Of You

The pandemic has changed so many things about the way we think and what we now expect. One of them is how doctors interact with their patients. Many doctors started communicating with their patients remotely in order to prevent the spread of infection and telehealth further grew in popularity due to its ease and convenience. Patients realized they didn’t need to take time off work, drive across town, and sit in waiting rooms. So, telehealth services grew and have now become the expected norm. Plus, virtual care provides a great opportunity for more people to receive quicker and more affordable access to medical professionals — wherever they live. However, it can also create unique challenges. Providers still need the capability to be face to face with patients for some things in order to holistically treat patients.

To begin, can you articulate for our readers a few of the main benefits of having a patient in front of you?

Dr. Janice Johnston: The main benefit is being able to be hands-on with patients in order to do the appropriate kind of examination. We don’t need them in-office, however, to gather most of the information we need to get started. Prescriptions, x-rays, and labs are easy to start over the phone when we have an established relationship. Even referrals to specialists or the Emergency Room can be done without an in-office visit most times. Of course, physical exams still require in-office interaction. There are also things that can only be picked up on by observing — like that someone is having trouble getting out of a chair or is short of breath. Sometimes people will fib about gaining weight as well and can be observed better in person.

Dr. David Berg: Our company operates a “virtual-first primary care — and in-office when necessary” model. We let everything start with a telehealth consultation so we can gather information to make an initial care plan and referral decisions, so we can to be prepared before-hand if they need to be seen in-office. Every mom and dad with a medical degree figured this out decades ago. They collect information first and figure out where their loved one needs to go next. COVID-19 and the pandemic sped up the need for virtual-first care. It is a natural way of doing things — to call the doctor first before we know where we should go for specialized care. Janice has done this for our family and friends a long time before Redirect Health was created as a healthcare company. We have access to the information we need readily and can save and spare many in-office doctor’s visits this way.

On the flip side, can you articulate for our readers a few of the main challenges that arise when a patient is not in the same space as the doctor?

Dr. Janice Johnston: There are some factors that can make virtual care more difficult for patients and providers. For one, sometimes patients don’t have a quiet or private place to go to for their call with the provider. In these cases, the patient may not always feel comfortable sharing everything. That’s why if works best to allow the patient to schedule the time most convenient to them so they can be prepared to get more from the virtual interaction.

Dr. David Berg: Living situations can also interfere with the ability to provide care virtually. There are many people who choose to live on the road or travel for work and they don’t realize the issues with medical insurance when traveling. If they are in another state, they need to ensure their medical provider is licensed in the state they are traveling to in order to receive care legally. Additionally, while rural areas could be one of the places that benefit the most from remote access to care, given that clinics and hospitals may be far from them, they also often have fewer wireless capabilities and internet access. This is changing quickly, however, and is unlikely to be a factor in the near future.

Fantastic. Here is the main question of our interview. Based on your experience, what can one do to address or redress each of those challenges? What are your “5 Things You Need To Know To Best Care For Your Patients When They Are Not Physically In Front Of You?

Make sure you are ready for that encounter/virtual visit:

1. Have the patient’s medical record in front of you.
2. Have foresight into the purpose of the appointment before the meeting to ensure they get all their questions and concerns addressed.
3. Remind your patient to make sure they are somewhere private to have an effective and engaging visit with a good internet connection.
4. Patients can bring someone to accompany them so make sure your patient is aware of this in case they want someone else present.

After the meeting, think about the follow up and the handoffs. Telehealth makes it easier to follow up than a brick and mortar visit ever did and is providing better results! With Telehealth you can quickly send an email or text to a patient, or make a brief phone call to discuss how they are feeling post treatment. This allows you to see if treatment worked, or if there is more that needs to be done, or lingering questions to be answered.

Can you share a few ways that Telehealth can create opportunities or benefits that traditional in-office visits cannot provide? Can you please share a story or give an example?

Dr. David Berg: Telehealth can help people have access to the knowledge they need.

Certain conditions are chronic and never go away entirely. They need to be continually managed, like diabetes or heart disease. With telehealth you have the ability to conveniently and inexpensively engage on a regular basis. It’s a great way to have a check in until someone gets to the “next step” with their care or maintenance plans. It allows providers to have more frequent follow-ups and make the necessary adjustments to optimize patient’s treatment plans without them having to lose time at work or driving or sitting in a waiting room.

Let’s zoom in a bit. Many tools have been developed to help facilitate Telehealth. In your personal experiences which tools have been most effective in helping to replicate the benefits of being together in the same space?

Dr. Janice Johnston: Video capabilities help providers see your patient in their surroundings. It helps with building that relationship and establishing trust. Patients can also send in pictures, or we can even take pictures DURING the video sessions so we can save them in the electronic medical record to refer back to later. Additionally, now providers can use their own mobile devices so they can be more available to patients and work faster now that additional measures for HIPAA and patient’s security are routinely in place.

Dr. David Berg: If you’re collecting information in the office that could have been done over the phone, you are creating inefficiencies in the office.

You can even listen to a heartbeat over the phone now using mobile applications like Echoes. Patients use their smartphones or utilize wearable sensors in order to provide their medical provider with data regarding their heartbeat. These technologies can be life changing in the way they collect medical data. Certain information can be collected simply just by asking a patient what their height and weight is, or about mental health specifics, and logging how this information changes over time. Still, there are many things that can’t be captured virtually because the technology just doesn’t exist yet. But this is changing quickly.

If you could design the perfect Telehealth feature or system to help your patients, what would it be?

Dr. Janice Johnston: Greater capability around sharing visual information back to a patient would be useful. For example, showing an x-ray of a broken bone.

Dr. David Berg: It would be a helpful and powerful tool if we could have something which reads a patient’s DNA. We’re likely quite some time from this reality though. There will be a day when we’ll have new and sooner insights into potential risks for serious issues that we can help prevent.

Are there things that you wish patients knew in order to make sure they are getting the best results even though they are not actually in the office?

Dr. David Berg- Because the investment in time is so much less for a virtual-first visit with a provider, and follow-up is so much easier than with and in-office visit. It’s also easier to wait to take action at first and reassess in the next couple days for situations where immediate action isn’t always necessary and can even be disadvantageous for the patient. There’s not the same pressure to fill a prescription right away that may not be needed if it can wait. There’s no additional cost for a follow-up call and we can interact in every language 24/7. The communication is bi-directional, not just aa one-time virtual visit.

Technology is rapidly evolving and new tools like VR, AR, and Mixed Reality are being developed to help bring people together in a shared virtual space. Is there any technology coming down the pipeline that excites you?

Dr. David Berg: Although VR, AR and Mixed Reality will certainly create some excitement and already these technologies have real utility for training medical professionals, I do not see them playing an important role in solving today’s biggest problems of meaningful access to healthcare and affordability anytime soon. Rather, I anticipate that the data science, neuro-network and AI technologies will soon be helping people eliminate the unnecessary healthcare activity and spending that is making basic healthcare inaccessible and unaffordable. In fact, Redirect Health currently has patents pending using this technology. AI is currently being used quite effectively and cheaply to assist with radiology, pathology and dermatology diagnosis. This will no doubt continue to improve and expand to the other medical specialties.

Is there a part of this future vision that concerns you? Can you explain?

Dr. Janice Johnston: I am excited about what the future of care looks like, but one concern I have is about whether everyone can afford it? I hope we can make it so everyone can take part in these potentially amazing advancements universally.

Dr. David Berg: I see issues with doctors, hospitals, insurance companies and the government not being able to keep up. And there will undoubtedly be powerful special interests that would like to see the future slow down. They make their profits in today’s world, so demonetizing and democratizing healthcare would initially threaten the existing business models. The transition to technology-based care will be stressful for some individuals also. In our company, Redirect Health, we started our electronic medical record system in 2003. We experienced many roadblocks and costs associated with moving so early with technology. When we made the decision to go electronic, we lost a quarter of our staff. Some of them didn’t know how to use the tech and some people didn’t like that we were changing. It was early and it was hard to find people who said it was a good idea. We’ve learned that there will always be different willingness to embrace the newest technology.

Ok wonderful. We are nearly done. Here is our last “meaty” question. You are a person of great influence. If you could inspire a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger. 🙂

Dr. Janice Johnston: Medicine and the cost of getting care is super complex and it’s hard to understand. We need to do a better job of making it truly transparent so people can understand what they are getting into. There has been a little bit of movement recently, but it is nowhere close to where it needs to be. It takes a team effort to get to the end result.

Dr. David Berg: I see a day soon when American businesses will realize they have the power and capability right now to make healthcare for their employees and families affordable (even free). Simple and truly affordable healthcare is available today. They would need to embrace a different healthcare system business model though — one that focuses on making money through the elimination of unnecessary activity and spending. It would certainly be one that increasingly incorporates new technology.

How can our readers further follow your work online?

They can visit our website & LinkedIn pages:

https://www.redirecthealth.com/

https://www.linkedin.com/in/janice-johnston-47a33817/

https://www.linkedin.com/in/drdavidfberg/

Thank you so much for the time you spent doing this interview. This was very inspirational, and we wish you continued success.

Source: Authority Magazine