The doctor is inside… but what’s behind that? Research reveals the impact of background settings in telehealth

Americans have become accustomed to their doctors and other healthcare providers using telehealth video visits over the past four years. But a new study shows that what a doctor has behind them during a telehealth visit can make a difference in how the patient thinks about him and his care.

Even if the doctor is miles away from their usual personal clinic or exam room, they should give the impression that they are there, the study suggests.

Even better: sitting in an office with their diplomas behind them – or perhaps having a virtual background, a photo of such an office. This is especially true if they have not seen the patient before, the study shows.

A home office with a bookshelf or plain background in solid colors are also acceptable to patients.

But providers should use blurred or virtual backgrounds if they conduct the visit in a home environment with a kitchen or bed in the background, the study found.

The findings come from a study in which patients were asked to respond to seven different backgrounds behind a model doctor, and to rate how knowledgeable, trustworthy, caring, approachable and professional the doctor appeared in each, and how comfortable the patient would feel with that provider. to feel. It also asked them to consider any background for an initial or recurring appointment with a primary care provider or a specialty care provider.

The research was published in JAMA network opened by a team from the University of Michigan Academic Medical Center, Michigan Medicine, and the VA Ann Arbor Healthcare System. More than 1,200 patients who had seen providers at one of the two health care systems completed the study surveys, and researchers compiled their responses.

Lead investigator Nathan Houchens, MD, is an associate professor of internal medicine at UM and associate professor of medicine at VAAAHS. His previous research on how interpersonal communication affects the patient-provider relationship – including nonverbal factors such as clothing and posture – led to the new telehealth study.

“The transition to virtual care was rapid and came without specific guidance during the onset of the COVID-19 pandemic, but telehealth appears to be here to stay, so it’s important to understand what patients prefer when it comes to the setting in which their healthcare provider is located. ” says Houchens, a hospitalist who collaborated with UM and VA general internist Jennifer Meddings, M.D., M.Sc., and others on the study.

He notes that during the first year of the pandemic, providers were urged to conduct telehealth visits outside of clinics if not necessary, to reduce the chance of COVID-19 transmission.

But now some clinics have created special spaces for providers to sit if they have telehealth appointments on days they also see patients in person. Some of these may be spaces shared with other doctors, so a virtual background could also reduce visual distractions.

Houchens notes that as the use of telehealth increased and became a standard way to receive care, some “webside way” guidelines have been proposed to guide providers in the ways they communicate verbally over a virtual connection. But very little information is available about the background of their video visits.

He and his colleagues were surprised at the extent to which patients disliked the kitchen and bedroom environments. Only 2% and 3.5% respectively said they preferred these backgrounds, compared to 35% for an office with degrees shown, 18% for a doctor. office, 14% for a solid colored background, and about the same for a home office with bookshelf or exam room.

There were also significant differences in the composite scores for how patients rated how each background would make them feel about receiving care from the provider. The bedroom and kitchen backgrounds received much lower composite scores than the other five backgrounds.

Houchens and colleagues, including co-author Sanjay Saint, MD, MPH, have published previous work on patient preferences for what doctors wear during clinical encounters. As with the background of video visits, these seemingly superficial factors can actually make a difference in the patient experience, he says.

“Patients have expectations of what physicians’ clothing and workspaces should look like. This study showed that patients prefer what used to be called traditional or professional clothing and environments,” he said. “Diplomas and credentials remind patients of the expertise they expect from a doctor, and conversely, something is lost when the background conveys a relaxed, informal home environment.”

The team is currently analyzing more data from the same study to assess other factors that influence patients’ telehealth experiences, including their access to high-speed internet and their ability to use necessary technologies.

But for now, they suggest providers can take immediate steps to conduct virtual visits from an office or exam space. Clinics may want to make unused clinical rooms available for use by providers conducting virtual visits during in-person clinic days.

Another option is to create virtual backgrounds that evoke these types of professional settings.

Houchens also notes that while they haven’t yet explored what doctors think about the backgrounds behind patients’ video visits, they could provide useful information.

The rise of ‘Hospital at Home’ and home care means that patients with more acute conditions can see their healthcare providers virtually, and that those around them can provide clues about how physical and social factors play a role in their health. . Discussing visible elements from both the provider’s and patient’s virtual background (for example, art and other hobby-related items) can also help build rapport, Houchens notes.

“This is a reminder that patients are often concerned about certain details that providers and health care systems may not have emphasized,” he said. “It is important to remember that our words and nonverbal behavior are taken to heart by those we care for, and it behooves us to care about them as well.”

Meddings and Saint are members of the VA Center for Clinical Management Research and the UM Institute for Healthcare Policy and Innovation. In addition to Houchens, Meddings and Saint, the study authors are Latoya Kuhn MPH, David Ratz MS, Jason M. Engle MPH of VA CCMR.