Checklist offers ways to improve communication during telemedicine visits with older patients

A new checklist presented real-world recommendations for optimizing communication during outpatient telemedicine encounters with older patients, who may be at risk for missing information or misunderstanding their clinicians during virtual visits.

First and most important, clinicians must assume that these patients have at least mild hearing loss, which is one of the most common chronic conditions among older adults, according to the checklist, which was developed by physicians from Johns Hopkins University School of Medicine and Johns Hopkins Bloomberg School of Public Health in Baltimore. The checklist was published online on Aug. 11 by Annals of Internal Medicine.

The telemedicine communication checklist offered the following additional strategies that clinicians can use before and during telemedicine visits with older patients, regardless of their hearing status, health, or comfort with technology:

• Confirm patients' preferences regarding visit format (e.g., landline, cellphone, or computer interface) in accordance with their technology access, proficiency, privacy concerns, and potential limits in internet or data plans;
• Ask patients to wear headphones or a headset or confirm that they are wearing their hearing aids or amplification device;
• Use the speaker function of the telephone as a backup if the patient's amplification device does not automatically connect or if the patient is struggling to hear you;
• Use a headset and avoid relying on built-in microphones;
• Use video whenever possible, at least on your end, to allow patients to view your face, read lips, and observe gestures;
• Light your face evenly and from the front to minimize shadows;
• Position the camera to focus on your face;
• Use automatic speech recognition captioning when available for video-based encounters;
• Confirm that the patient is in a quiet location and minimize background noise;
• Be aware of cues that the patient is not following the conversation and address the issue early;
• Speak slowly and clearly;
• Minimize raising your voice too much, which can cause distortion;
• Repeat but then rephrase if the patient does not hear or understand you;
• Use teach-back techniques, preferably throughout the visit; and
• Provide a written summary of key points and instructions.

“The overarching goal is to ensure that you and your patient have optimized the setup so that all patients have access to effective communication and the opportunity to connect regardless of format or distance,” the authors wrote.