Telehealth Brings Opportunities to Enhance Patient Care

Massachusetts General Hospital rheumatology fellows presented virtual didactic conferences based on rheumatology cases to primary care providers at Rosebud and its surrounding health centers. These sessions were precepted, so fellows received feedback and guidance, while primary care physicians, nurse practitioners and physician assistants received helpful education. Another initial part of Dr. Bolster’s Foundation grant—having fellows provide precepted, in-person assessment to patients at Rosebud followed by precepted, virtual follow-up care—was disrupted by the timing of the pandemic.

This underscores another important contrast between deliberately employed telehealth and the telehealth experience many were thrust into in March 2020: Dr. Bolster points out the benefits of an initial in-person visit were quite clear even before the pandemic. Instead, Dr. Bolster’s project pivoted so the rheumatology fellows, with her precepting and supervision, could gain experience participating in an e-consult service to provide helpful information that becomes part of the patient’s medical record.

Shared Decision Making

Dr. Zickuhr, assistant professor of medicine in the Division of Rheumatology and associate director for the rheumatology fellowship program at Washington University School of Medicine in St. Louis, focused her research project on best practices for shared decision making during virtual care encounters.

Dr. Zickuhr said multiple studies have shown that medical providers often think they are engaging patients in shared decision making during in-person visits, but patients often do not share this perspective. Shared decision making requires effective communication, respect for patient autonomy and active, patient-centered participation.⁶ Some of these factors may be especially challenging to achieve during virtual encounters.

Dr. Zickuhr

Dr. Zickuhr noted that several patient advocacy groups reported the move to telemedicine during the pandemic made patients feel they had lost their voice. This improved somewhat as both providers and patients became more comfortable in the new medium, but Dr. Zickuhr explained that providers need to be aware of this possibility and work to actively keep centering on patients’ experiences, needs and perspectives.

In her work, Dr. Zickuhr has held a series of focus groups with both medical providers and patients with chronic conditions, mostly rheumatologic disorders. “We found that both parties generally agree that decisions can be made during telehealth appointments, and that there are pros and cons to in-person vs. telehealth care,” she said.

Dr. Zickuhr pointed out that technology can enhance the way clinicians impart information—for example, by sharing a screen shot, putting information in a chat conversation or even continuing a conversation with a provider through shared message exchanges in a secured patient portal.