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  • Writer's pictureDr. Ja-Nae Duane

Environmental Considerations for Effective Telehealth Encounters

Doctor and patient on a virtual telehealth appointment
Image generated by Revolution Factory using MidJourney

Does the thought of consulting with your doctor in your flannel jammies sound appealing? For many, the promise of telehealth can seem like a dream come true. No more packed waiting rooms or uncomfortable exam rooms. Imagine doctors appointments that work around your schedule, taken from the familiar comfort of your own home.

Now expand your vision and think of the immunocompromised, pregnant, bedridden, or disabled patient who can now speak with their doctor with only a computer and an Internet connection. Such an idea, once akin to science fiction, has now become a reality, necessitated by the COVID pandemic. Telehealth is the new frontier.

However, despite the promise of telehealth, most clinicians lack evidence-based guidance on how to best use video conferencing to enhance their patient’s experience and outcomes. This lack of guidance can lead to bad experiences that might otherwise be avoided with some simple “best use” practices.

Think back on your own experiences with Zoom calls during the early stages of the pandemic. Someone over here was trying to figure out how to unmute themselves. Someone over there was so close to the camera, you could see right up their nose. Another was cloaked in darkness like a witness protection interviewee. And lest we forget that poor Texas lawyer who was trapped by a cat filter (I am not a cat!) during a Zoom call with a judge?

We can laugh about these, but simple changes in lighting, positioning and angles, and a better understanding of the technology can go a long way from turning a comical situation into a more appropriate one. In the context of serious, sensitive, or private information conveyed from a doctor to a patient, these environmental factors can make a huge difference.

To address this, our group at Bentley set out to review how environment affects telehealth visits and to offer suggestions of “good practices” to maximize the experience for patients. We reviewed findings from the fields of social psychology, environmental psychology, human–computer interaction (HCI), and health care communication.

We distilled our research down to seven key themes surrounding the environment for telehealth visits:

Reduced non-verbal cues: microexpressions, hand gestures, and gaze are all cues that can be interrupted by bad connections or angles or bandwidth delays

Control resulting from symmetry: telehealth environments create a shared space between doctor and patient that bridges physical distance and offer more of a sense of control for the patient

Environmental impact on individual impressions: how we arrange our homes and work spaces can offer many clues to our personality and how we conduct ourselves, for both patients and doctors.

Spatial distance cues: things like having your face too close to the camera can be off-putting, while having a desk between the doctor and patient can seem too formal.

Environmental spaciousness: our sense of space and openness can affect how we perceive information. This can sometimes be distorted as virtual environments tend to “shorten” spaces.

Ambient environmental and clinician features: lighting and color have a direct effect on mood and can enhance or detract from an environment. Even things like a physician’s tone and voice can be a factor.

Digital interfaces: a U/I interface that is confusing or difficult to navigate can negatively impact a telehealth session.

Based on these themes, we developed a visual typology of best practices that could easily and effectively alter the telehealth environment for a more productive visit. These were split into four main areas.

Professionalism Cues

What does this mean? Avoiding unprofessional attire like tee-shirts, etc.; wearing professional clothing that conveys expertise; and avoiding unprofessional backgrounds or locations.

Proximity to the Camera

This is a lot like the story of Goldilocks. We don’t want someone sitting too far away or too close to the camera. We want to see a middle zone where we can easily see our doctor’s hands, arms, and head and shoulders.

Spatial Distance Cues

We want to keep our focus on our doctor. So we’re looking for backgrounds that aren’t too busy and distracting. At the same time, we don’t want to see a cluttered foreground (like a desk). Ideally, we would have a clean space with minimal professional cues.

Ambient Features

Lighting, sound, and colors make a difference. We want to avoid loud or pervasive noises and spot lighting and stick to warm, natural, and diffuse lighting. And keep away from the witness protection look by avoiding low light and dark backgrounds.

As you can see, these subtle tweaks to the telehealth environment can make a difference. They are not difficult to implement and can be embraced without extensive cost or time.

Professional situations demand professional interactions and encourage physicians to become more conversant in these methods. We also think best practices like these should be both a part of the medical education curriculum and the U/I design of telehealth portals.

The more we can amplify the vital non-verbal cues of the doctor and further empower the patient, the more we can create lasting and beneficial relationships and build trust and comfort in telehealth platforms.

To dive deeper into this topic, check out our research and insights on enhancing the telehealth environment and improving patient experiences. If you have any questions or need more information, don't hesitate to contact me and my team.

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