Abstract
Telemedicine has seen a rapid expansion lately, with virtual visits ushering in telediagnosis. Given the shift in the interpersonal and technical aspects of communications in a virtual visit, it is prudent to understand its effect on the patient-provider relationships. A range of interpersonal and communication skills can be utilized during telemedicine consultations in establishing relationships, and reaching a diagnosis. We propose a construct of “webside manner,” a structured approach to ensure the core elements of bedside etiquette are translated into the virtual encounter. This approach entails the totality of any interpersonal exchange on a virtual platform, to ensure a clinician’s presence, empathy and compassion is translated through this medium.
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Research funding: None declared.
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Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
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Competing interests: Authors state no conflict of Not applicable.
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Ethical approval: Not applicable.
References
1. Teichert, E. Training docs on “webside manner” for virtual visits. Modern Healthcare; 2016. Available from: https://www.modernhealthcare.com/article/20160827/MAGAZINE/308279981/training-docs-on-webside-manner-for-virtual-visits [Accessed Dec 2020].Search in Google Scholar
2. McConnochie, KM. Webside manner: a key to high-quality primary care telemedicine for all. Telemed J e Health 2019;25:1007–11. https://doi.org/10.1089/tmj.2018.0274.Search in Google Scholar PubMed
3. Hall, JA, Roter, DL, Rand, CS. Communication of affect between patient and physician. J Health Soc Behav 1981;22:18–30. https://doi.org/10.2307/2136365.Search in Google Scholar
4. Ha, JF, Longnecker, N. Doctor-patient communication: a review. Ochsner J 2010;10:38–43.Search in Google Scholar
5. Duffy, FD, Gordon, GH, Whelan, G, Cole-Kelly, K, Frankel, R, Buffone, N, et al.. Participants in the American Academy on Physician and Patient’s Conference on Education and Evaluation of Competence in Communication and Interpersonal Skills. Assessing competence in communication and interpersonal skills: the Kalamazoo II report. Acad Med 2004;79:495–507. https://doi.org/10.1097/00001888-200406000-00002.Search in Google Scholar PubMed
6. Herndon, JH, Pollick, KJ. Continuing concerns, new challenges, and next steps in physician-patient communication. J Bone Joint Surg Am 2002;84:309–15. https://doi.org/10.2106/00004623-200202000-00019.Search in Google Scholar PubMed
7. Greenfield, S, Kaplan, S, Ware, JEJr. Expanding patient involvement in care. Effects on patient outcomes. Ann Intern Med 1985;102:520–8. https://doi.org/10.7326/0003-4819-102-4-520.Search in Google Scholar PubMed
8. Zaman, JAB. The enduring value of the physical examination. Med Clin North Am 2018;102:417–23. https://doi.org/10.1016/j.mcna.2017.12.003.Search in Google Scholar PubMed
9. McCoul, ED. Grasping what we cannot touch: examining the telemedicine patient. JAMA Otolaryngol Head Neck Surg 2020;146:685–6. https://doi.org/10.1001/jamaoto.2020.1266.Search in Google Scholar PubMed
10. Sanders, JH, Bashshur, RL. Challenges to the implementation of telemedicine. Telemed J 1995;1:115–23. https://doi.org/10.1089/tmj.1.1995.1.115.Search in Google Scholar PubMed
11. Paley, L, Zornitzki, T, Cohen, J, Friedman, J, Kozak, N, Schattner, A. Utility of clinical examination in the diagnosis of emergency department patients admitted to the department of medicine of an academic hospital. Arch Intern Med 2011;171:1394–6. https://doi.org/10.1001/archinternmed.2011.340.Search in Google Scholar PubMed
12. Loane, M, Wootton, R. A review of guidelines and standards for telemedicine. J Telemed Telecare 2002;8:63–71. https://doi.org/10.1258/1357633021937479 [Accessed 27 Feb 2021].Search in Google Scholar PubMed
13. Hollander, JE, Carr, BG. Virtually perfect? Telemedicine for Covid-19. N Engl J Med 2020;382:1679–81. https://doi.org/10.1056/nejmp2003539.Search in Google Scholar PubMed
14. Bashshur, RL. On the definition and evaluation of telemedicine. Telemed J 1995;1:19–30. https://doi.org/10.1089/tmj.1.1995.1.19.Search in Google Scholar PubMed
15. AAMC. Telehealth competencies across the learning continuum. AAMC new and emerging areas in medicine series. Washington, DC: AAMC; 2021. Available from: https://www.aamc.org/system/files/2020-09/hca-telehealthcollection-telehealth-competencies.pdf [Accessed 27 Feb 2021].Search in Google Scholar
16. Academy of Communication in Healthcare, (ACH). COVID-19 telehealth guide. ACH: Lexington, KY; 2020. Available from: http://achonline.org/Portals/36/COVID-19%20Resources/Covid-19%20telehealth%20FINAL.pdf [Accessed 27 Feb 2021].Search in Google Scholar
17. Smith, T. To succeed with telehealth, know your webside manner. AMA; 2020. Available from: https://www.ama-assn.org/practice-management/digital/succeed-telehealth-know-your-webside-manner [Accessed 27 Nov 2020].Search in Google Scholar
18. Sinsky, CA. Pre-visit planning: save time and improve care. AMA Ed Hub website; 2014. Available from: https://stepsforward.org/modules/previsit-planning [Accessed 3 Dec 2020].Search in Google Scholar
19. Lomas, T, Medina, JC, Ivtzan, I, Rupprecht, S, Eiroa-Orosa, FJ. A systematic review of the impact of mindfulness on the well-being of healthcare professionals. J Clin Psychol 2018;74:319–55. https://doi.org/10.1002/jclp.22515.Search in Google Scholar PubMed
20. Krasner, MS, Epstein, RM, Beckman, H, Suchman, AL, Chapman, B, Mooney, CJ, et al.. Association of an educational program in mindful communication with burnout, empathy, and attitudes among primary care physicians. J Am Med Assoc 2009;302:1284–93. https://doi.org/10.1001/jama.2009.1384.Search in Google Scholar PubMed
21. Edgoose, JY, Regner, CJ, Zakletskaia, LI. Breathe out: a randomized controlled trial of a structured intervention to improve clinician satisfaction with “difficult” visits. J Am Board Fam Med 2015;28:13–20. https://doi.org/10.3122/jabfm.2015.01.130323.Search in Google Scholar PubMed
22. Verghese, A. The importance of being. Health Aff 2016;35:1924–7. https://doi.org/10.1377/hlthaff.2016.0837.Search in Google Scholar PubMed
23. Brown-Johnson, C, Schwartz, R, Maitra, A, Haverfield, MC, Tierney, A, Shaw, JG, et al.. What is clinician presence? A qualitative interview study comparing physician and non-physician insights about practices of human connection. BMJ Open 2019;9:e030831. https://doi.org/10.1136/bmjopen-2019-030831.Search in Google Scholar PubMed PubMed Central
24. Sheridan, T. Musings on telepresence and virtual presence. Presence Teleoperators Virtual Environ 1992;1:120–6. https://doi.org/10.1162/pres.1992.1.1.120.Search in Google Scholar
25. Prescher, S, Deckwart, O, Winkler, S, Koehler, K, Honold, M, Koehler, F. Telemedical care: feasibility and perception of the patients and physicians: a survey-based acceptance analysis if the telemedical interventional monitoring in heart failure (TIM-HF) trial. Eur J Prev Cardiol 2013;20:18–24. https://doi.org/10.1177/2047487313487483e.Search in Google Scholar PubMed
26. Thomas, KB. General practice consultations: is there any point in being positive? Br Med J 1987;294:1200–2. https://doi.org/10.1136/bmj.294.6581.1200.Search in Google Scholar PubMed PubMed Central
27. Chua, IS, Jackson, V, Kamdar, M. Webside manner during the COVID-19 pandemic: maintaining human connection during virtual visits. J Palliat Med 2020;23:1507–9. https://doi.org/10.1089/jpm.2020.0298.Search in Google Scholar PubMed
28. Brock, DM, Mauksch, LB, Witteborn, S, Hummel, J, Nagasawa, P, Robins, LS. Effectiveness of intensive physician training in upfront agenda setting. J Gen Intern Med 2011;26:1317–23. https://doi.org/10.1007/s11606-011-1773-y.Search in Google Scholar PubMed PubMed Central
29. Beck, RS, Daughtridge, R, Sloane, PD. Physician-patient communication in the primary care office: a systematic review. J Am Board Fam Pract 2002;15:25–38.Search in Google Scholar
30. Little, P, White, P, Kelly, J, Everitt, H, Mercer, S. Randomised controlled trial of a brief intervention targeting predominantly non-verbal communication in general practice consultations. Br J Gen Pract 2015;65:e351–6. https://doi.org/10.3399/bjgp15x685237.Search in Google Scholar
31. Langewitz, W, Denz, M, Keller, A, Kiss, A, Rüttimann, S, Wössmer, B. Spontaneous talking time at start of consultation in outpatient clinic: cohort study. BMJ 2002;325:682–3. https://doi.org/10.1136/bmj.325.7366.682.Search in Google Scholar PubMed PubMed Central
32. Rabinowitz, I, Luzzati, R, Tamir, A, Reis, S. Length of patient’s monologue, rate of completion, and relation to other components of the clinical encounter: observational intervention study in primary care. BMJ 2004;328:501–2. https://doi.org/10.1136/bmj.328.7438.501.Search in Google Scholar PubMed PubMed Central
33. Singh Ospina, N, Phillips, KA, Rodriguez-Gutierrez, R, Castaneda-Guarderas, A, Gionfriddo, MR, Branda, ME, et al.. Eliciting the patient’s agenda - secondary analysis of recorded clinical encounters. J Gen Intern Med 2019;34:36–40. https://doi.org/10.1007/s11606-018-4540-5.Search in Google Scholar PubMed PubMed Central
34. Robertson, K. Active listening: more than just paying attention. Aust Fam Physician 2005;34:1053–5.Search in Google Scholar
35. Hall, JA, Bernieri, FJ. Interpersonal sensitivity: theory and measurements. New Jersey, USA: Lawrence Erlbaum Associates; 2001.10.4324/9781410600424Search in Google Scholar
36. Hall, JA. Clinicians’ accuracy in perceiving patients: its relevance for clinical practice and a narrative review of methods and correlates. Patient Educ Counsel 2011;84:319–24. https://doi.org/10.1016/j.pec.2011.03.006.Search in Google Scholar PubMed
37. Weng, HC, Steed, JF, Yu, SW, Liu, YT, Hsu, CC, Yu, TJ, et al.. The effect of surgeon empathy and emotional intelligence on patient satisfaction. Adv Health Sci Educ Theory Pract 2011;16:591–600. https://doi.org/10.1007/s10459-011-9278-3.Search in Google Scholar PubMed
38. Zulman, DM, Haverfield, MC, Shaw, JG, Brown-Johnson, CG, Schwartz, R, Tierney, AA, et al.. Practices to foster physician presence and connection with patients in the clinical encounter. J Am Med Assoc 2020;323:70–81. https://doi.org/10.1001/jama.2019.19003.Search in Google Scholar PubMed
39. Blanch-Hartigan, D. Patient satisfaction with physician errors in detecting and identifying patient emotion cues. Patient Educ Counsel 2013;93:56–62. https://doi.org/10.1016/j.pec.2013.04.010.Search in Google Scholar PubMed
40. van Houwelingen, CT, Moerman, AH, Ettema, RG, Kort, HS, Ten Cate, O. Competencies required for nursing telehealth activities: a Delphi-study. Nurse Educ Today 2016;39:50–62. https://doi.org/10.1016/j.nedt.2015.12.025.Search in Google Scholar PubMed
41. Levinson, W, Gorawara-Bhat, R, Lamb, J. A study of patient clues and physician responses in primary care and surgical settings. J Am Med Assoc 2000;284:1021–7. https://doi.org/10.1001/jama.284.8.1021.Search in Google Scholar PubMed
42. Branch, WT, Malik, TK. Using ‘windows of opportunities’ in brief interviews to understand patients’ concerns. J Am Med Assoc 1993;269:1667–8. https://doi.org/10.1001/jama.269.13.1667.Search in Google Scholar
43. Zulman, DM, Verghese, A. Virtual care, telemedicine visits, and real connection in the era of COVID-19: unforeseen opportunity in the face of adversity. J Am Med Assoc 2021;325:437–8. https://doi.org/10.1001/jama.2020.27304.Search in Google Scholar PubMed
44. Eberly, LA, Kallan, MJ, Julien, HM, Haynes, N, Khatana, SA, Nathan, AS, et al.. Patient characteristics associated with telemedicine access for primary and specialty ambulatory care during the COVID-19 pandemic. JAMA Netw Open 2020;3:e2031640. https://doi.org/10.1001/jamanetworkopen.2020.31640.Search in Google Scholar PubMed PubMed Central
45. Institute of Medicine (US). Committee on the future health care workforce for older Americans. Retooling for an aging America: building the health care workforce. Washington (DC): National Academies Press (US); 2008.Search in Google Scholar
46. Donaghy, E, Atherton, H, Hammersley, V, McNeilly, H, Bikker, A, Robbins, L, et al.. Acceptability, benefits, and challenges of video consulting: a qualitative study in primary care. Br J Gen Pract 2019;69:e586–94. https://doi.org/10.3399/bjgp19x704141.Search in Google Scholar PubMed PubMed Central
47. Levine, DM, Lipsitz, SR, Linder, JA. Trends in seniors’ use of digital health technology in the United States, 2011–2014. J Am Med Assoc 2016;316:538–40. https://doi.org/10.1001/jama.2016.9124.Search in Google Scholar PubMed
48. Anderson, M, Perrin, A. Tech adoption climbs among older adults. Washington DC: Pew Research Center; 2017. Available from: https://www.pewresearch.org/internet/2017/05/17/tech-adoption-climbs-among-older-adults/ [Accessed 22 Feb 2021].Search in Google Scholar
49. Anthony, DL, Campos-Castillo, C, Lim, PS. Who isn’t using patient portals and why? Evidence and implications from a national sample of US adults. Health Aff 2018;37:1948–54. https://doi.org/10.1377/hlthaff.2018.05117.Search in Google Scholar PubMed
50. Lam, K, Lu, AD, Shi, Y, Covinsky, KE. Assessing telemedicine unreadiness among older adults in the United States during the COVID-19 pandemic. JAMA Intern Med 2020;180:1389–91. https://doi.org/10.1001/jamainternmed.2020.2671.Search in Google Scholar PubMed PubMed Central
51. Kang, HG, Mahoney, DF, Hoenig, H, Hirth, VA, Bonato, P, Hajjar, I, et al.. Center for integration of medicine and innovative technology working group on advanced approaches to physiologic monitoring for the aged. In situ monitoring of health in older adults: technologies and issues. J Am Geriatr Soc 2010;58:1579–86. https://doi.org/10.1111/j.1532-5415.2010.02959.x.Search in Google Scholar PubMed
52. George, SM, Hamilton, A, Baker, R. Pre-experience perceptions about telemedicine among African Americans and Latinos in South Central Los Angeles. Telemed J e Health 2009;15:525–30. https://doi.org/10.1089/tmj.2008.0152.Search in Google Scholar PubMed PubMed Central
53. Lee, S, Martinez, G, Ma, GX, Hsu, CE, Robinson, ES, Bawa, J, et al.. Barriers to health care access in 13 Asian American communities. Am J Health Behav 2010;34:21–30. https://doi.org/10.5993/ajhb.34.1.3.Search in Google Scholar PubMed PubMed Central
54. Ngo-Metzger, Q, Legedza, AT, Phillips, RS. Asian Americans’ reports of their health care experiences. Results of a national survey. J Gen Intern Med 2004;19:111–9. https://doi.org/10.1111/j.1525-1497.2004.30143.x.Search in Google Scholar PubMed PubMed Central
55. Street, RLJr, Makoul, G, Arora, NK, Epstein, RM. How does communication heal? Pathways linking clinician-patient communication to health outcomes. Patient Educ Counsel 2009;74:295–301. https://doi.org/10.1016/j.pec.2008.11.015.Search in Google Scholar PubMed
© 2021 Walter de Gruyter GmbH, Berlin/Boston
Articles in the same Issue
- Frontmatter
- Editorial
- From Camille Nούς to Apollonian and the Dionysian scientists
- Review
- The role of D-dimer in periprosthetic joint infection: a systematic review and meta-analysis
- Mini Reviews
- Updated picture of SARS-CoV-2 variants and mutations
- Systematic review and cumulative meta-analysis of the diagnostic accuracy of glial fibrillary acidic protein vs. S100 calcium binding protein B as blood biomarkers in observational studies of patients with mild or moderate acute traumatic brain injury
- Opinion Papers
- The 6C model for accurately capturing the patient’s medical history
- Webside manner: maskless communication
- Original Articles
- Ways that nurse practitioner students self-explain during diagnostic reasoning
- Diagnostic reasoning: relationships among expertise, accuracy, and ways that nurse practitioner students self-explain
- Perspectives on the current state of pre-clerkship clinical reasoning instruction in United States medical schools: a survey of clinical skills course directors
- Use of a structured approach and virtual simulation practice to improve diagnostic reasoning
- Analyzing diagnostic errors in the acute setting: a process-driven approach
- Morning report goes virtual: learner experiences in a virtual, case-based diagnostic reasoning conference
- Stroke hospitalization after misdiagnosis of “benign dizziness” is lower in specialty care than general practice: a population-based cohort analysis of missed stroke using SPADE methods
- Discrepancy between emergency department admission diagnosis and hospital discharge diagnosis and its impact on length of stay, up-triage to the intensive care unit, and mortality
- Automated capture-based NGS workflow: one thousand patients experience in a clinical routine framework
- Short Communication
- Characterizing the relationship between diagnostic intensity and quality of care
- Case Reports – Lessons in Clinical Reasoning
- Lessons in clinical reasoning ‒ pitfalls, myths, and pearls: a case of confusion, disequilibrium, and “picking at the air”
- Hickam’s dictum, Occam’s razor, and Crabtree’s bludgeon: a case of renal failure and a clavicular mass
- Letters to the Editor
- Three learning concepts to improve diagnosis and enhance the practice of medicine
- Distributed cognition: a framework for conceptualizing telediagnosis in teams
- Performance of Fujirebio Espline SARS-CoV-2 rapid antigen test for identifying potentially infectious individuals
Articles in the same Issue
- Frontmatter
- Editorial
- From Camille Nούς to Apollonian and the Dionysian scientists
- Review
- The role of D-dimer in periprosthetic joint infection: a systematic review and meta-analysis
- Mini Reviews
- Updated picture of SARS-CoV-2 variants and mutations
- Systematic review and cumulative meta-analysis of the diagnostic accuracy of glial fibrillary acidic protein vs. S100 calcium binding protein B as blood biomarkers in observational studies of patients with mild or moderate acute traumatic brain injury
- Opinion Papers
- The 6C model for accurately capturing the patient’s medical history
- Webside manner: maskless communication
- Original Articles
- Ways that nurse practitioner students self-explain during diagnostic reasoning
- Diagnostic reasoning: relationships among expertise, accuracy, and ways that nurse practitioner students self-explain
- Perspectives on the current state of pre-clerkship clinical reasoning instruction in United States medical schools: a survey of clinical skills course directors
- Use of a structured approach and virtual simulation practice to improve diagnostic reasoning
- Analyzing diagnostic errors in the acute setting: a process-driven approach
- Morning report goes virtual: learner experiences in a virtual, case-based diagnostic reasoning conference
- Stroke hospitalization after misdiagnosis of “benign dizziness” is lower in specialty care than general practice: a population-based cohort analysis of missed stroke using SPADE methods
- Discrepancy between emergency department admission diagnosis and hospital discharge diagnosis and its impact on length of stay, up-triage to the intensive care unit, and mortality
- Automated capture-based NGS workflow: one thousand patients experience in a clinical routine framework
- Short Communication
- Characterizing the relationship between diagnostic intensity and quality of care
- Case Reports – Lessons in Clinical Reasoning
- Lessons in clinical reasoning ‒ pitfalls, myths, and pearls: a case of confusion, disequilibrium, and “picking at the air”
- Hickam’s dictum, Occam’s razor, and Crabtree’s bludgeon: a case of renal failure and a clavicular mass
- Letters to the Editor
- Three learning concepts to improve diagnosis and enhance the practice of medicine
- Distributed cognition: a framework for conceptualizing telediagnosis in teams
- Performance of Fujirebio Espline SARS-CoV-2 rapid antigen test for identifying potentially infectious individuals