Cancer Treatment Centers of America

Toufic Kachaamy

The healthcare system is not known for rapid transformation or adaptation. For example, physicians are still using fax for communication. In case you do not know what a fax is, please do not be concerned that you are missing amazing technology that doctors keep to themselves. The COVID-19 pandemic forced physicians and the healthcare system to quickly adopt telehealth, a healthcare delivery model that previously struggled to play a big role despite being available for over a decade.

While this presented an amazing opportunity to broaden safe access to many more patients from the comfort of their electronic devices, it also created new challenges that need not be ignored. Some of these challenges are obvious and include the inability to obtain vital signs such as blood pressure and oxygen level or performing a physical exam. Other challenges such as building good rapport and conveying empathy can be more difficult to measure and study.

As a physician who sees many patients for a second or third opinion, I often ask them what led them to seek further opinions. Many times, the motivation is a lack of connection with their clinician and discomfort with how the information about their diagnosis and treatment was communicated. Patients, consciously and subconsciously use many factors to connect with their clinician. These factors go beyond the content of the message and include voice tone, body posture, facial expressions, and eye contact. Skilled providers can relate to the concerns and suffering of their patients and show clear signs of empathy during their encounters. In this healthcare environment where physicians are battling burnout and struggling to build a rapport during the in-person visit, telehealth visits can exacerbate this struggle.

"Many times, the motivation is a lack of connection with their clinician and discomfort with how the information about their diagnosis and treatment was communicated"

The solution to this issue is multifaceted and includes technical, regulatory, and education. Regulators and healthcare systems are trying to define what is appropriate for telehealth and some have limited it to follow-up visits where a relationship and hopefully a rapport has already been established with the patient. Using virtual reality headsets for virtual visits has been explored in mental health treatment such as PTSD, pain control, and rehab services, and might be interesting to study for regular visits and assess their impact on building a good rapport.

In the meantime, simple measures such as a camera in the middle of the screen and high-resolution screens that allow eye contact would be nice. Providers currently are well versed in the science of medicine and have little training in the art of medicine and building good relationships. They would benefit from education and training on how to build rapport and show empathy during a telehealth visit. Since a Cochrane review (a major medical authority) on telehealth in 2019 found that there is insufficient evidence and research to conclude its impact on healthcare many studies have documented its benefits and much more research is needed to assess the long-term impact of the wide adoption of telemedicine. As a physician who takes pride in establishing a strong rapport with my patients, I continue to find an in-person visit significantly more powerful than a remote one. I have also had multiple patients who refuse telehealth visits despite their convenience. In an environment where physicians feel often like a commodity and patients feel like a disease or a number, we need to be careful to make sure telemedicine is part of the solution and not the problem.