As initial step, plugin your computer or mobile device. The last thing you want is for your power to die in the middle of the visit and video processing consumes a lot of energy. Make sure your computer or mobile device is either fully charged or plugged-in before the remote visit starts. Then close unnecessary programs. Having too many unnecessary software running on your computer or device can interfere with your video.
Commercial products such as Skype, WhatsApp or Facetime can be considered where you urgently need to have video consultation with a patient and if alternative channels are not available. From you side, take care to communicate using tools that use end-to-end encryption. On the other side, it is the patient’s responsibility to ensure that they have adequate anti-spyware and anti-virus protection on their equipment/devices. If patients are using a mobile phone, they must be made aware that it can only be as secure as any other phone call on that mobile network.
Where possible, for patients who are less familiar with the technology you are using, consider doing a test call to allow the patient to try it out and check that the video and audio works before the consultation. Get the patient's phone number in case there are technical difficulties so you can phone them and, in every case, have ready a back-up option in case of lastminute technical issues.
Use a high quality webcam that you can move around to point at your face at eye-level to obtain eye contact with the patient and ensure they feel that you are engaging with them. Patients who can clearly see your face will feel more comfortable with the interaction and respond more positively to the visit. Of course, you will need to make sure your patient is using a webcam that is sufficient as well as the connection bandwidth. Use and recommend wired internet connection when possible. It is fine to do a virtual visit over a wi-fi connection, but your computer is less likely to lose connection if it is plugged directly into the internet with a wired an ethernet cable. If you are on a phone and you are experiencing bandwidth issues, try connecting to your home of office wi-fi.
Lightning is the major factor affecting video quality, even more then the camera quality and resolution. Before you start a virtual visit, test out the lighting. The best possible light source should be white, frontal and diffused. To do so, you can point a powerful lamp to the ceiling or to a nearby wall in front of you. If the ceiling or wall colour is white, then the light will diffuse and you face will be lightened homogeneously? If that setup is not possible, then try turning on overhead lights and blocking light from lateral or back windows.
Take also care of the audio quality by using quality sound equipment. Most computers and high-quality cameras have a decent built-in microphone and speakers. Test yours out using a sound recording program on your computer or by doing a call or video chat with a friend. Can the other person clearly hear you? Do you need to talk more loudly or get closer to the mic? Can you hear them ok? Built-in microphones may be directional thus ensuring a good audio volume only when you are perfectly in front of the computer. In that case, usage use external omnidirectional Lavalier microphones with is recommended. To optimize the listening from the patient, break up your explanations into short chunks. Repeat them if necessary and elicit reactions and questions regularly.
If you are doing a virtual visit from home or after-hours, make sure you are dressed professionally. Presenting a professional appearance will reinforce that the virtual visit is just as professional an interaction as if the patient had come into your office. The colour of your clothes should be soft and try to avoid tiny strips that cause a bad Moiré effect on the video. Additionally, make sure the space is quiet and you are not likely to get interrupted. Eliminating distractions and ensuring patient privacy is crucial to your patient’s satisfaction with the visit.
Take a minute or two before starting the virtual visit to read the patient complaint, as you might with an inperson visit, as well as having the patient’s medical history on-hand, in digital or in paper form. You will be more prepared for the visit and will likely make the appointment more efficient. Frequently checking and informing the patient about the remaining time will help ensuring adherence to the schedule, but do not cut the patient off. Studies have shown that patients take an average of 32 seconds to state their health concerns – yet physicians, on average, cut in after 20 seconds and redirect the conversation. If a patient has a story to tell, let him/her. There may be more in that story to help the diagnosis.
Remember that the summary and teach-back are vital. You may consider typing the recommendations into the after-visit summary as you speak. Be sure to assess the patient’s understanding of your co-created plan, elicit questions, and define next steps, including a follow-up appointment as needed. When listing or summarising key points, tag each element using numbers or letters. Since it is possible that something could have been missed due to technical interferences, numbering will make easier for the patient to recognize if some element has been really missed. Finally, encourage the patient to sign up for the patient portal or any other tool to facilitate ongoing communication.