Why Telehealth Consults are Better Than Face-to-face – Wisdom From Dr. Jay Sanders

The conventional telehealth benefit that most people talk about is that with telehealth you’re saving time and money by bringing care to the patients rather than requiring them to go to where the care can be delivered.

A common example of this is tele-cardiology where a cardiologist or nurse can remotely see a patient at home by video-conference and also capture key vitals like heart rate and blood pressure from devices the patient has at home.

This approach has proven to keep the patient from being admitted or re-admitted to the hospital because key changes in their physical condition are caught before they get so bad that the patient has to go to the ER.

But as Dr. Sanders points out, there’s much more to it than that.

The key is to remember that the patients spend very little of their time in the doctor’s office. Most of their time is in a different environment – home, work, school, etc.

And so, the environmental factors that influence them can be very different from those in the doctor’s office.

For example, imagine you have an asthmatic patient and need to check her lungs and breathing. Traditionally, you can examine her at the doctor’s office. Oddly, the patient might breath fine in the relatively clean, sterile air of the doctor’s office.

With telehealth, you can check her in her own environment, whether it is at home, work, or somewhere else.

Perhaps her home environment is full of secondhand smoke. Perhaps her work environment has dust particles or other allergens flying around.

You can get a much clearer diagnosis of the patient when you conduct it in the patient’s physical environment.

Telehealth Advantage #2: Telehealth brings care to where the patient lives – emotionally

Now, let’s take this to the emotional level.

Dr. Sanders provides another great example here.

Imagine you have a heart patient.

Every time he comes in to the cardiologist’s office, his resting heart rate appears high and you think he has some form of tachycardia. So you work him up with all kinds of tests, and don’t find anything.

But you call him back in for another visit and another set of tests. Just to “keep an eye” on his “condition.”

Well, every time he comes in, if he is stressed out thinking …“Is there something wrong with my heart?” his resting heart rate will be abnormally high.

Now, if you could test this patient at home where he is around all the things he is familiar and comfortable with, his resting heart rate may actually be normal.

So the insight is that the doctor’s office can actually be introducing stress factors that the patient does not normally get exposed to in his normal life.

You would be treating him for stress created by the fact that you’re treating him!

With telehealth, you’re bringing care to patients in their normal emotional settings as well.

Whether the environment is good or bad, you’re going to get a much more accurate read on the patient’s “real-world” condition as opposed to the artificial setting of the doctor’s office or hospital.

In sum, with telehealth, what you can learn about patients in their home environment is very different from what you can learn about them when they are in the doctor’s office.

Telehealth Advantage #3:Telehealth gives you more control over the treatment environment

A common objection to telehealth is that when delivering care, physicians are unable to get access to the same information that they would get face-to-face.

For example, psychiatrists will say that a remote consultation will remove the “ambiance”, i.e. the special environment they have between themselves and their patient.

They are concerned with losing the intimacy of the encounter, and the benefits that brings to the doctor-patient relationship.

Early in his telehealth career, Dr. Sanders heard these arguments from leading psychiatrists whom he was trying to convince to use telehealth (because it would save them a lot of commuting time).

Well, he got them to try it and guess what they found?

They discovered what to them was a breakthrough. Yet to any movie director this “discovery” would have been obvious.

The camera (used for the video conference) actually enabled the psychiatrists to control their environment in better ways than a face-to-face.

For instance, when they were talking to a drug addict and really wanted to emphasize a point, they could lean in towards the camera.

Because the patient was looking at the doctor on the screen and not at the surroundings in the room, this visual image of their psychiatrist “getting into their face” saying “I really need you stop doing that,” would leave a stronger, more emotional impression on the patient.

And on the flip side, if the physician wanted to help the patient relax or to de-emphasize something that troubled the patient, he could sit back and make the camera zoom away from himself to create the impression that the issue was less important.

Movie directors already know that when creating a film, you can use the camera’s zoom, focus, panning, lighting, etc. to set the mood. The audience sees what the camera tells them to see.

While obvious to movie directors, this was new for tele-psychiatrists.

The camera was more than just an efficient window to the patient. It was a treatment tool.

This was really effective and the psychiatrists that Dr. Sanders was working with went from being telehealth skeptics to telehealth advocates.

Today, these tools are commonly used by practitioners of telemental health, telepsychiatry, etc.

The big lesson is that even though telehealth may take some things away, it can add other things.

So when you’re convincing people to support telehealth, it’s important to look for ways that telehealth can add to the consult in ways that a face-to-face cannot.

Final thoughts

Telehealth has some big advantages over face-to-face consults.

It enables you to assess patients in their own physical and emotional environments.

It even enables you to influence the special environment created during a telehealth consult.

Share this with skeptics.

As healthcare increasingly shifts away from bringing patients to care and towards bringing care to where patients are, telehealth will bring unique opportunities that traditional care approaches cannot.

Ask yourself “What am I assuming?” And be open to the possibilities.

And to Dr. Jay Sanders – thank you for helping to open up a world of possibilities.