| Safety |
Verify the patient’s location/contact information at the beginning of the encounter. Ensure that the patient’s physical and virtual environments are secure and private, including from other family/household members. Obtain informed consent for the visit. Use headphones to ensure patient confidentiality unless you are in a private space. Proceed according to patient comfort level; obtain consent for examinations, minimize removal of clothing, and proceed with follow-up discussions once the patient is clothed. During an examination, avoid personalizing language such as “[instruction] for me” or “show me your [body part]”.36 Consider instead: “In order to help us treat you, it would be useful for me to examine the arm. Would you mind rolling up the sleeve so that I can see the rash?” Provide education/information on safety resources that can be accessed virtually (eg, crisis hot lines).
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| Trustworthiness and transparency |
Actively listen to the patient’s concerns about their health and/or the telehealth environment. Alert the patient to possible ambient noises. Sit far enough from the screen that the patient can see your body language, which also helps to ensure the appearance of better eye contact through the camera. Provide the patient with time to adapt to the telehealth environment. Provide clear information on changes to scheduling, access, and contact process. Dress professionally for the visit and avoid busy, unprofessional backdrops.
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| Peer support |
Consider developing and/or referring to telehealth groups (eg, PTSD, DM support groups). Provide information on virtual peer support.
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| Collaboration and mutuality |
Thank the patient for connecting with their medical team using this care modality. Collaboratively identify and develop an agenda for the visit. Partner with the patient to attain goals and mitigate treatment challenges.
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| Empowerment, voice, and choice |
Follow patient preferences regarding extent of the visit; some may prefer to just talk or test the connection for their first appointment. Assure the patient that they may choose to end the visit at any point. Allow the patient to choose the room where the visit takes place. Emphasize that the topic of discussion can change, even abruptly, when needed.
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| Cultural, historical, and gender Issues |
Use gender-affirming language (including patient’s pronouns). Encourage/praise the patient’s willingness to try this care modality. Consider social determinants of health during the visit (eg, housing stability, food insecurity, impact of racism). Be sensitive to the patient’s feelings in revealing their personal space during the visit; refrain from comment about their home/living space. Seek ways to make telehealth accessible to those who lack devices/Internet access or need an interpreter.
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