Telehealth Tips to Preserve Key Aspects of Patient Care

Malathi Srinivasan demonstrates remote physical exam technique


The COVID-19 pandemic has transformed the way many physicians are practicing medicine. Social distancing measures and efforts aimed at reducing the spread of the virus have shifted physician-patient encounters to virtual interactions and required providers to navigate challenges presented by a technology barrier.

To ensure that doctors are able to properly care for and connect with their patients via video, Stanford Medicine professors and faculty have developed two powerful tools with guidance and best practices for conducting telehealth visits.

Malathi Srinivasan and Maja Artandi’s Problem-Based Approach to the Provider-Directed Patient Self-Exam is a 16-minute instructional video with tips and strategies for administering a remote physical exam. According to a Stanford Medicine news release, the video features three examples—the upper respiratory infection exam, the low back exam, and the shoulder pain exam— to demonstrate directed self-exams. Srinivasan says patients are quite capable of participating in an exam when instructed properly, and the provider is able to make an informed and educated decision related to care.

In the video, the two professors offer recommendations, such as avoid looking down at an individual’s picture. Instead, they say, “look directly into the lens, so it looks like you’re making eye contact.” Srinivasan notes that the approach will also nurture the physician- patient connection that is typically strengthened through in-person interactions.

Additionally, Meredith Fischer, Megha Shankar, Sonoo Thadaney Isran, Abraham Verghese and Donna Zulman have adapted their five practices to foster physician presence and connection with patients in the clinical encounter for application during a telemedicine visit. The faculty members say that while “technology can generate a barrier to the human connection that is central to clinical care,” the evidence-based techniques, named Tele-Presence 5: A Ritual of Connection for Virtual Visits, will “help clinicians foster humanism during [virtual] clinical encounters.”

STAT recently reported that “COVID-19 has pushed the inevitable telemedicine revolution.” We frequently discuss the physical exam as a pillar of medicine, both from a diagnostic standpoint and as a ritual that reinforces a strong relationship between doctor and patient. At a time when more medical appointments may transpire via technology, we are excited by these valuable resources that allow physicians to preserve essential aspects of care.

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