The COVID?19 health emergency has led many Headache providers to transition to virtual care overnight without preparation. We review our experience and discuss tips to bring humanity to the virtual visits.

Introduction

Human presence is intrinsically engrained in the way we practice medicine. Being physically present for our patients throughout their medical trajectories is much more comforting than words alone. When we sit together with our patient, it allows all of us to establish a connection. Harrison’s Principles of Internal Medicine begins by acknowledging that despite more than 70 years of scientific and technological progress since its 1st edition, “a trusting relationship between physician and patient still lies at the heart of successful patient care.”

Most of the diagnostic process comes through observation. Dr. Norma Braun, a Clinical Professor of Medicine at St Luke’s Hospital in New York City with 55 years of experience, always tells her mentees: “You have to watch and see; and listen and hear.” When greeting our patient in the waiting room, we observe their posture, the way they stand up, their gait, their handedness, whether they have company, whether they are struggling with the intake form, listening to music, reading a book, or playing with their phones. As Dr. Ronald Epstein describes in Attending: Medicine, Mindfulness, and Humanity, accompanying patients back to the waiting room after a visit shows them that we will continue to be there for them.

Transitioning from in?person visits to virtual visits without training due to the COVID?19 health emergency came as a shock. Even Bates’ Guide to Physical Examination and History?Taking does not guide us (yet) as to how to conduct a thorough virtual visit. In our field, there is paucity of literature on the topic.13 One of the authors, OBdD, noted how she felt naked without her ophthalmoscope or reflex hammer, but the issue was much deeper than that. That 1st virtual visit during the COVID?19 health emergency showed OBdD how much she relies on body language, the exam, and observation to build a human connection and make a diagnosis. The authors (OBdD and CB) have spoken of wanting to pass a patient a tissue when hearing sobs –and being unable to do so. OBdD and CB felt reassured that some of their colleagues had the same experience about the impersonalizing nature of virtual visits. Hence, OBdD and CB have decided to share the techniques they use to attempt to bring some humanity between the distanced screens.

Consent

The authors start each visit by 2?way patient identification and oral consent to participate in a telehealth visit. They discuss that the visit will not be recorded in any way. If a patient asks, they recommend against recording the visit and offer to invite family members to join the telemedicine visit if the patient needs extra support. They also recommend asking patients if there are anyone else in the room with them, out of the range of the camera.

Video

The authors find it easier to build human connection with video visits than phone visits; it is genuinely heartwarming to make eye contact and be able to see patients’ facial expressions and responses. Even if virtual, video capability enables communication via body language. Providers have to be mindful to look at the camera directly and not at the screen where the patients’ eyes appear so that providers appear to look in their patients’ eyes.4

 

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