Pearls of Wisdom
Practicing in a Virtual Care Era
“The patient-physician relationship is the foundation of good clinical practice. How we communicate with a patient impacts our ability to make sound clinical decisions. The flow of information between the patient and the doctor informs our clinical reasoning: both from the perspective of history taking and conducting a physical examination. Virtual care provides us with the opportunity to be more mindful than ever of what we are saying or asking and how we are doing that. Keeping the relationship between the patient and the physician in the centre, as the fulcrum, is now more important than ever because virtual care is a novel and modified environment for patient encounters. Active listening and keen observational skills continue to be key characteristics of a good doctor. Virtual care allows us the opportunity to maintain clinical care where in-person appointments are not feasible, however that does not mean that it is a perfect substitution. Remain curious about the value of both virtual and in-person care, seek to be the best physician you can be by focusing on the most important part of medicine, the patient-physician relationship.”
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----Dr. Alenia Kysela, Deputy Head, Department of Family Medicine, Queen’s University
“Make sure you call patients in every few visits even if there doesn’t seem to be a “reason “ to do this. There is nothing like seeing a patient in front of you to fill in the gaps.”
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----Dr. Mark MacKenzie, Postgraduate Program Director of Family Medicine, University of British Columbia
“We have run into trouble early on knowing how to securely submit narcotic prescriptions, when we don’t have a fax at home and don’t wish to rely on the security of email and/or iCloud. If you have an EMR that you can directly upload photos to from your own mobile device, into a patient’s chart, then this can be a way to add tamper-resistant narcotic prescriptions to the patient’s chart. If you take the photo directly in the EMR app with the prescription laid on an 8.5x11” piece of blank paper, then a secretary in the office or at home could print that securely from the chart to fax and it looks just like they faxed the prescription themselves.”
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----Dr. Russell Dawe, Director Family Medicine Residency Training Program, Faculty of Medicine, Memorial University of Newfoundland
Teaching in a Virtual Care Era
“When using a telemedicine platform such as Zoom for Healthcare, the share screen option is extremely valuable. My student and I use the share screen to collaborate to create progress notes, e-prescriptions and update the CPP after each patient encounter. This helps to provide a more comprehensive learning experience.”
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-----Dr. Parm Singh, Markham Family Health Team
“With regards to providing virtual care for our refugee patients, we use RIO interpretation services, and with their service we can contact the translator first and then the translator will call the patient and connect us directly. I advise the interpreter in advance what message to leave on the voicemail if there’s no one home. So, making a plan for language barriers and arranging for interpretation, when needed, ahead of time is key.”
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----Dr. Russell Dawe, Director Family Medicine Residency Training Program, Faculty of Medicine, Memorial University of Newfoundland
“Ensure that you have an ergonomic set up and try to take screen breaks and walk around and stretch for 1-2 minutes every half an hour to minimize eye strain and back and leg pain.”
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----Dr. Deepti Pasricha, Markham Family Health Team
“Virtual care is still care - so “lean in" to it - active listening goes a long way; be attentive to tones of voice (aural equivalent to body language); and when in doubt, bring in for an in-person exam - your patients will love you for it! (I know this goes against the principles of virtual care, but sometimes patients need to be seen); especially chest pain, headaches, abdominal pain and babies (with no fever!)”
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----Dr. Edward Seale, Postgraduate Program Director of Family Medicine, University of Ottawa
“Given the inability to see the patients all the time (ie not everyone uses video), use the opportunity to get a VERY complete history and “FIFE” - not only will you do a better job at establishing a differential diagnosis, but you will practice for the inevitable.”
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----Dr. Edward Seale, Postgraduate Program Director of Family Medicine, University of Ottawa
Communicating with Specialists and other HCPs
“Remind office staff to update patient emails, other demographics and pharmacy information to help improve the efficiency of your virtual call.”
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----Dr. Deepti Pasricha, Markham Family Health Team