The coronavirus pandemic has shifted our entire social landscape, with practically every aspect of our day-to-day lives affected. These changes have extended to the healthcare arena, transforming how we provide care and how we communicate with patients.
Healthcare providers, or HCPs, are challenged to establish and maintain excellent patient relationships in an era of telemedicine, masks, information and misinformation overload, and mistrust. Patient-provider relationships have been shown to be an important predictor of patient outcomes. In one study, patients with poor provider relationships were shown to be high utilizers of emergency room services, rather than relying on their primary providers.
HCPs must find ways to transition into our “new normal” and continue to provide excellent patient outcomes by adapting to these changes. Here are some current challenges in the patient-provider relationship and strategies for overcoming them.
Combat overload with clear information
Patients are beset by frequently conflicting advice and information on COVID-19. Clear communication from your practice is essential to easing patient concerns and presenting reliable factual guidance. The California Medical Association suggests the following methods for effective communication with patients:
Email patients to explain office safety protocols. Letting patients know your specific expectations and the protections you have put in place for your practice ahead of their visit allows them to prepare and know what to expect.
Leverage social media. Using social platforms to your advantage will help you effectively convey helpful information to your patients and point them to your website for further details.
Place straightforward signage in and around your office outlining safety protocols. These signs inform patients who may be unaware of your protocols to ensure adoption and compliance.
Masking and distancing are making care harder
The patient-provider relationship involves verbal as well as nonverbal communication. Masking and social distancing, while necessary to prevent virus transmission, are two factors that will inevitably affect the ability to sustain positive patient relationships. Dual masking, where both the HCP and the patient must both wear masks, provides an even more significant impact, resulting in adverse effects of mutual empathy and trust.
Additional impacts of masking include the following:
Diminished volume and clarity of voices, especially affecting those with hearing impairment or relying on lip-reading
Lack of visibility of facial expressions for reading and sending emotional cues
Inability to discern subtle voice tone changes
Distancing prohibits everyday social interactions such as handshakes and therapeutic touches. Losing these types of interactions creates obstacles for perceptions of empathy and compassion, which studies have shown have a remarkably positive impact on healing. Privacy issues can also come into play with the need for distance, as speaking louder can increase the risk of encounters being overheard.
To counteract the detrimental effects of masking and social distancing, consider the following strategies:
Introduce yourself at every encounter, as face masks and face shields make it hard for patients to tell healthcare team members apart.
Replace therapeutic touch with expressions of empathy through verbal statements that respect, acknowledge, and validate emotions.
Use “face sheets.” A headshot photo with your name and information allows patients to see your face and humanizes members of the healthcare team.
Address any sensory issues up front by asking about impairments, and obtain any needed assistive devices. Speak slowly and clearly, and ask for repetition of the information to gauge understanding.
Employ technology to allow significant others to hear and contribute to the visit in areas where additional visitors cannot accompany the patient.
Telemedicine has trade-offs
Telemedicine and virtual visits are an alternative method for providing healthcare during the pandemic. Telemedicine offers advantages for patients and providers concerned about coronavirus exposure, but also presents its own set of problems.
The advantages of virtual visits include the following:
Limiting exposure of patients and staff
Conserves the use of PPE
Provides a method of triaging patients that need an in-person visit
Can expedite the time from the referral of a patient to evaluation
Here are the challenges associated with virtual visits:
Harder to building rapport
Limited physical exam
Difficulties in observing interactions with family members and caregivers
Snafus associated with technology and internet connectivity
While patients appreciate telemedicine’s convenience, some criticisms of the delivery method include a perception that HCPs pay less attention during a virtual visit. Providers control the flow of conversation, making it more challenging to ask questions, and that HCPs often seem rushed and less engaged.
Improving the virtual visit
Applying the following techniques can help ensure a more effective virtual visit and an improved patient relationship:
Maintain a professional appearance. Dress appropriately for the clinical setting.
Understand and test equipment beforehand. You may need to be able to assist patients with their technology during the visit.
Make eye contact through the camera. Most people look at the individual on the screen. Directing your view into the camera gives the impression of direct eye contact, which improves interactions on video.
Check your physical space. The space should be clean, quiet, free of background noise, not distracting, and free from interruptions during the visit.
Give the patient your undivided attention. Try to avoid taking notes. Establish rapport at the onset of each visit, and be aware of your facial expressions throughout.
Build and maintain relationships
While the pandemic has changed many aspects of our lives, patients continue to yearn for meaningful relationships built on trust with their HCPs. COVID-19 has created challenges in our usual communication methods; however, with thoughtful interventions and creative problem-solving, providers can continue providing the compassionate care and excellent outcomes that patients expect.
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