There is no doubt that we are currently in unprecedented territory in healthcare! I wanted to come up with a blog topic that was relevant to what is happening in healthcare right now but did not necessarily focus on COVID-19. My husband came up with the idea (I even admitted that he had a good idea;)) to talk about my recent experience with conducting telephone visits. In this blog, I share what has worked and how I have modified my telephone interactions with patients along the way.
Pre-visit calls
We call our patients days prior to their scheduled visit to discuss conducting the appointment via telephone. The pre-visit calls have proven to be a helpful way to identify those who need to be physically seen. This approach is permitted if warranted based on the clinical situation. We have identified that some folks want to come in because they sought a personal connection. We stress to patients that their health is our top priority and that we will schedule an in-person visit if there is evidence that one is needed during their telephone appointment.
Here is what I have learned since starting pre-clinic calls:
- Call the patient several days in advance of the appointment vs. waiting until the weekday prior. This may prevent patients from cancelling their appointments due to the valid concern with coming on-site. You may also put the patient's minds at ease by letting them know that they will still have a visit. Many have assumed that visit will be cancelled. We have reinstated appointments that have been preemptively cancelled by the patient.
- Identify yourself on the call before asking for the patient by name. Many are cautious of sales calls and have told me that they do not answer unknown, blocked or private numbers. I have texted those who do not return calls after leaving two voicemails. Suggested text wording - “This is Dr. XYZ calling from Your Friendly Practice site. Please call me at <<insert number>> at your convenience”. This has worked like a charm. Protected health information should not be included in messages.
- Ask your patients to have their medications, and over-the-counter and herbal products with them at the time of their scheduled appointment. Encourage patients to write down questions or concerns before the appointment and have these readily accessible too. I practice at a heart failure clinic and ask patients to have their weight log ready.
Getting ready for the actual appointment
My tips:
- Check out the national and state or local orders regarding COVID-19.
- Be on the look out for false information that is being propagated during this pandemic (e.g., probiotic use or drinking water to prevent infection). This piece that outlines some incorrect information that has been shared: https://bit.ly/2UUDj2C.
Keep an eye out for topics related to medications that are making their way into the news or on social media. For instance, headlines inappropriately suggest that continued use of an
angiotensin converting enzyme inhibitor or angiotensin II receptor blocker could be harmful at this time. We all know that patients should keep taking these medications; however, headlines
like this one
https://bit.ly/2QZ6pwy can lead patients to think otherwise. Self-discontinuation in my patient population could be incredibly detrimental unless there is a clinical reason to stop.
You may even want to proactively address some of these topics versus waiting to be asked.
3. Identify resources that are available in your community. Your patients may not have the ability to find these or know where to start looking.
4. Know how to connect patients to the right services if concern for their mental health is raised during the call.
“Clinic” appointment telephone call
Here is what I have found to be helpful:
1. These unprecedented times are incredibly hard for patients, and likely most challenging for those who live alone and/or do not have easy access to purchase necessary goods. My favorite
part of patient care is making connections with people. Please take a little time to see how your patient is coping during this time - to me this is the heart of what we need to offer to our
patients right now. Give your patients a chance to talk about non-health related topics for as long as you can allow. You may be their only personal contact that day or even in recent days.
I start out the call by finding out what each patient is doing to keep occupied and if they live with others. Provide suggestions on what to do to pass the time, if it seems that this would
benefit the patient. Remember that patients do not always have the same privileges as you do. One of my patients mentioned that playing games on the tablet and reading books is a
great way to pass his time. The patient is having paper/hardback books delivered. We had a good laugh when I suggested downloading the free library app and reading e-books on the
patient’s tablet. He got a real kick out of me thinking that he could do this. The only time things are put onto his tablet are when their children and/or grandchildren are around to do so.
2. Educate your patients on best practices to prevent contracting and/or spreading COVID-19. Better to assume that they do not know all of the facts.
3. It is inevitable that remote access will go down during at least one visit. Do not panic!! You know exactly what to ask your patients. This has happened to me. I explained the remote
access challenge and that I would follow-up after our call in the event that I identified anything in the chart that we needed to discuss. Recommend calling the patient back once you are
able to get back online even if there is nothing new to discuss. I have no doubt that the patient will appreciate you closing the loop.
You may be the brightest part of someone’s day by putting a smile on someone’s face and warmth in their heart.
Would love to hear your telemedicine tips. Please reply to this post or send a tweet or direct message to me on Twitter. My handle is @cards_pharm_gal.