Now that we’re eight months into the coronavirus pandemic, most providers have had experience with virtual, or telehealth, visits. These visits have been a necessary, and very convenient way to continue to safely provide patients with care.
Like many other hospitals around the country, Boston Children’s had to ramp up telehealth services quickly at the start of the pandemic. And since March, our clinicians have learned some valuable tips and tricks for making visits with patients most effective.
To gain insight on what works well — and not so well — we spoke with Keneisha Sinclair-McBride, PhD, and Erica Lee, PhD, psychologists in the Department of Psychiatry at Boston Children’s, and frequent users of virtual visits.
1. Consider the age of the child
Your approach to a virtual visit should consider the child’s age. “I find that a lot of teens really love virtual visits because they are so used to communicating virtually,” says Sinclair-McBride. “They appreciate the more casual feel of the visit, even though it’s health-oriented. They also like being in their own space, maybe hanging out with a pet in their room. I’ve had some really great conversations with teens on virtual visits.”
She says that younger children also do well with virtual visits, as long as their parents are available to be with them for at least a portion of the visit. “I often have them do an activity like draw a picture for me or show me a favorite fidget toy, which works well,” she says. “The toughest crowd is kids in the preteen years. They are old enough to not want parents as involved but still young enough to not be used to serious conversations happening virtually, so you may need to work harder to engage them.”
For children who seem awkward or unsure about the virtual visit, Sinclair-McBride suggests explaining the structure of the visit. “For example, if I were giving advice to a primary care provider, I might have them explain to the patient what it means to have a well visit, the steps involved, and what they can expect.” She may also suggest that they plan the order of agenda items for the visit together. This gives kids a sense of control over the visit.
2. Maintain privacy
When you’re meeting in an office, both you and your patients can easily assess the privacy of your environment. This is not the case during a virtual visit.
“Since you can only see what’s directly in front of the screen, it can be difficult to tell if a family member or friend is sitting just outside of the frame,” says Lee. “So it’s important to talk with your patients about how to create a secure, safe location to speak with you. I let kids know that even though we’re not in the office together, their privacy and confidentiality are still a priority for me.”
Lee says that while parents are often involved in virtual visits, children and teens should have a time at each visit to speak with their provider privately and ask questions, just as they would in an office setting.
She acknowledges that not all families enjoy the luxury of having a private setting for their child to meet with their provider, especially if their space is limited or other family members are home. “For kids who don’t have their own private spot, I may suggest their parents turn on the television or play music at a low volume in the next room, put in headphones, or use a noise machine to create a cocoon of privacy. Depending on the family’s situation, we’ll troubleshoot together to come up with a plan that feels comfortable.”
When necessary, Lee speaks directly to parents to reinforce privacy needs. “Parents want to be supportive and involved in their children’s care. When in their own homes, it can be easy to forget about the privacy factor, so offer supportive reminders and problem solve together how to approximate the boundaries you usually have in the office.”
3. Ask how they’re doing
We’re living in a strange and unprecedented time. Don’t discount how that might be affecting your patients. “Taking a moment to really ask how your patient is doing can help orient you to their current situation and mindset,” says Sinclair-McBride. “Talk openly about what’s happening right now, but be careful not to give it a negative lens, because some kids really like how the pandemic has allowed them and their families to be home more.”
She also pays attention to what’s going on in the background. “Seeing patients in their own space gives you insight that you don’t get in the office. A lot of people are struggling right now and if you see that the family is having issues with resources, such as technology, talk with your team social worker.”
4. Find ways to connect
Connecting with patients virtually may not come naturally to everyone. If you need a little help building rapport or getting the conversation started, Lee and Sinclair-McBride offer these tips.
- Look for something in the child’s background to comment on, such as a poster, trinket, or pet. This lets them know you see them.
- Keep some fun and interesting things in your own office so kids have something to look at and comment on. “Kids are curious about your life too,” says Lee. “With virtual visits, you have opportunities to relate to your patients in new ways.”
- Ask kids about themselves. “When you ask what they enjoy doing, reflect on their responses, and express real interest, that makes them feel heard,” says Sinclair-McBride.
- Use a visual aid. “Boston Children’s has enhanced the virtual visits application, and we can now use the screen-sharing function to easily share handouts and information with patients and parents,” says Lee. “Kids can also use this function to share with you, which can help make virtual visits more engaging and productive.”
- If it’s really not working, reschedule. “Some kids may just not be feeling up to meeting for a number of different reasons, whether it’s related to emotional dysregulation or another issue,” says Sinclair-McBride. “Try again another day, and if it’s really not working, you may want to consider scheduling an in-person visit.”
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