Managing Barriers to Virtual Care: Tips for Doctors

The full version of this article originally appeared on Dr. Bill.

Shifting some of your clinic time to a virtual environment is a new and exciting way for physicians to work. While it may take some adjustments to your style of practice, there are so many benefits to going virtual – like additional flexibility with your hours and the ability to operate from home.

While studies show most Canadians are overwhelmingly in favor of virtual care, there are still large sections of the population who feel some things are too sensitive to ask a doctor online. How can you accommodate these patients? What are some barriers to virtual care that you might experience when practicing virtually and how to address them? Here are some suggestions for you to consider:

Barrier #1: Technology

The first barrier to providing great virtual care is the most obvious one. Younger Canadians are happy with the new options for seeing a doctor in Canada, however, older Canadians – especially those over 45 – are more resistant to the changes in medical practice. This isn’t surprising, given the usage gap with various technologies within and around this age group – internet use among Canadians under 54 has reached near saturation, compared to only 68% of Canadian seniors.

This might seem like a minor gap, but it’s a big problem for providing virtual care, especially when it comes to digital opinions. Only 22% of seniors believe digital technology helps you to communicate easier, and an even smaller amount (16%) believe it saves you time. According to the Canadian Medical Association, ease of communication and timely access to care are two of the main justifications for moving to virtual care in the first place. When you take into account Canada’s aging population – and the pressures on the medical system to accommodate this – getting a greater number of seniors willing to transition into virtual care is more important than ever.

So how can you help? Start by taking stock with your staff or other physicians in your practice of what’s involved with a patient appointment from beginning to end. Things you take for granted – like the physical challenge of using a mouse, the mental cognition of handling a dropdown menu, or even visual barriers like overlapping tabs or windows in a browser can present a challenge to seniors. Where can your digital process be simplified? Are there paper instructions you could pass out at your clinic for seniors interested in transitioning to digital care? Can their appointment be moved to a phone call or in-person visit? Could you ask the patient’s comfort level with technology before booking, or ask if they have a friend or family member available to help?

Barrier #2 – Language

Virtual clinics, email reminders, or text messaging services might be hard for people who speak other languages to use, and recent immigrants to the country might not have or be able to afford the digital tools they need to show up for their appointment.

In person, a patient can get around these communication barriers with the use of translation apps or books, a receptionist to help them make their next appointment, reminder phone calls to follow up on, or patient handouts to take home. They can also carry a prescription to the pharmacy of their choice, while your virtual prescription will need to be faxed to the correct location. Even your body language, gestures, or demeanor in the office can tell a patient a lot about what you’re saying if they don’t understand the language, and connectivity problems or poor video quality can make you even harder to understand.

So where do you start? Like with seniors, addressing language barriers in virtual care starts with not taking your knowledge for granted. Go over some trouble areas of patient care with your staff before implementing your virtual clinic. Can you have staff ask patients whether they have the tools to access a video call at home? Could you give out a patient handout with community resources and ask if they are able to access them, or upgrade your computer equipment to add clearer sound or picture to the call?

If there are a lot of barriers to your virtual appointment, the best route might be directing the patient to your office for an in-person visit – have your staff check with the patient beforehand to see if this is an option they would prefer.

Barrier #3 – Privacy & Relationship Building

Some medical problems can be hard to tell your doctor about in the clinic, let alone ask a doctor online. Even if they’re not a new patient, many people feel shy about connecting with their doctor in a digital way, and doubly so if the call is about a personal issue that could be embarrassing. This is especially true with older adults, only 30% of whom would be interested in using online care for a sensitive issue.

In addition, some patients risk family members or spouses eavesdropping, and this could lead to medical issues. For example, patients asking about sensitive mental health issues might be guaranteed privacy in your office, but have more difficulties when they need to ask a doctor online thanks to family members or spouses listening in on the call. To address these issues, start out your virtual appointments by asking your patients if they are in a quiet or private space. If they’re not, you could suggest using headphones, moving somewhere else in the home, or closing the door.

Significant privacy or sensitivity issues might warrant an in-person appointment, so have staff screen patients as best they can beforehand, and remember that any appointment requiring physical examination should be conducted in the office.

Barrier #4 – Literacy

Literacy statistics in Canada can be surprising. A staggering 48% of Canadians read below a high school level, and 17% of Canadians would be unable to read even basic instructions. These patients get by in their day to day activities by relying on in-person cues and signage. But what happens when something like healthcare goes virtual? Another area you and your staff may take for granted is the amount of reading involved.

Everything from automated text message reminders for appointments to email communication from your office to the instructions on how to set up video chatting software can be more difficult for someone who has trouble with reading – and unlike seniors or those with language barriers, these problems are often difficult to see. Patients who have trouble with literacy may feel embarrassed telling this to your staff or receptionist, and might not want to ask a friend or family member for help – so the biggest thing you as a physician can do in this case is remember not to push.

There are many types of appointments that need to be conducted in person and you’ll likely be spending time in both your clinic and your virtual office, so have your staff let all patients know this option is still available if they choose.

Whether it’s an embarrassing topic that they’d prefer not to ask a doctor online, a barrier with language or technology, or a problem with literacy, there are several aspects of Canada’s move to a virtual healthcare environment that could present patient roadblocks you might not have thought of. A compassionate, well rounded approach to virtual care should take some precautions to these roadblocks ahead of time so all your patients can have their needs met – whether or not they’re ready to step into the new digital age.

Read related story: 5 Quick Tips for Launching Your Own Virtual Clinic