Webside Care Can Enhance Rheumatology Training & Patient Satisfaction

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Many practitioners can relate to the epiphany of Roy Basch, MD, the lead character in Samuel Shem’s satirical novel The House of God.¹ During his first on-call shift as a medicine intern, long work hours combined with jaded advice from his senior resident leave Dr. Basch feeling disenchanted with the medical profession until he cares for a 50-year-old man with a pleural effusion from newly diagnosed lung cancer. The authentic, meaningful interactions with his patient reestablish Dr. Basch’s sense of purpose as a physician and help him find satisfaction among the chaotic and sometimes comedic events he encounters in the hospital. This turn in storyline highlights the importance and impact of the relationship Dr. Basch and his patient form at the bedside.

Patients and practitioners find satisfaction in the therapeutic bonds they establish at the bedside.^2,3 The time physicians spend interacting with patients and their families imparts meaning to their work.² Practitioners’ job satisfaction is associated with increased provider well-being, greater clinician empathy and improved patient health outcomes.⁴

Accordingly, the Accreditation Council for Graduate Medical Education has campaigned to support educational initiatives that bring patient care and education back to the bedside in an effort to reorient providers to factors that fulfill and sustain them.⁵

With the COVID-19 pandemic, virtual care has become an essential facet of healthcare delivery, especially in the form of real-time video visits. Patients report high satisfaction levels with these encounters, and studies have demonstrated that providers can deliver quality healthcare for their patients through virtual care.⁶

Benefits

This model of healthcare delivery introduces new opportunities to strengthen therapeutic relationships, while enhancing patient care and enriching clinical training. With these benefits, virtual care invites our practice to a new side of medicine: the webside.

When transitioning from in-person to virtual care encounters, patients and practitioners interact through webside manner. Webside manner diverges from bedside manner with a greater reliance on non-verbal communication. Effective webside manner cultivates relationships and reinforces clinician empathy when practitioners actively listen without interrupting, appropriately use facial expressions, maintain eye contact with the camera and utilize vocal tone in their virtual discussions with patients.

Non-verbal communication is amplified at the webside because real-time video focuses on participants’ faces, eliminating some of the physical distance that exists in a clinical exam room. Non-verbal communication skills refined in the virtual care setting can then be applied to conversations held during in-person ambulatory care to enhance patient-provider communication.

Videoconferencing platforms leverage technology to facilitate patient-provider interactions. When the electronic health record (EHR) was introduced to the clinical environment, technology was perceived as a barrier to effective, meaningful communication between patients and providers. The challenges associated with integrating the EHR into patient care as well as the mounting administrative workload associated with the EHR, contributes to physician burnout.⁷

Notably, virtual care situates all components of patient care into one platform, because the patient encounter and its associated electronic record occur in the same portal. Practitioners interact with their patients, document the encounter, and share laboratory and radiographic information in a single workspace. In addition, these tasks can be completed while communicating with patients and their families, conveying empathy and demonstrating effective webside manner, via a single computer screen.

Several features of patient care encoun­ters that appear disparate in the in-person ambulatory environment merge during virtual care, subsequently increasing providers’ focus on their patients and redirecting the clinician to more rewarding and enriching aspects of patient care.