27 Nov The Therapeutic Alliance in Telehealth
Two recent articles on telehealth hit home with me. The first was in the online publication Tech Crunch and the second in the Harvard Business Review. They each address some of the challenges facing providers and patients as telehealth adoption grows. In this blog I focus on patient engagement and the Therapeutic Alliance in telehealth. I’ve taken the examples used in primary care and drawn parallels to how we address these issues at TelaPT.
The issues raised by each article existed prior to mass telehealth adoption. Patients have felt like numbers in the healthcare system for years and that has eroded their faith in their providers, making successful outcomes more challenging to achieve. We mostly accept this lack of engagement as the status quo. COVID and the “Telehealth Revolution” have actually created an opportunity to make a shift. We address this issue by keeping patients engaged with their TelePT and our practice. We can improve the Therapeutic Alliance between patients and providers. Now is the time to do it.
Why are Telehealth companies treating healthcare like the gig economy? – Tech Crunch 11/17/2020
The central theme of this article is that patients are seen by a different provider every time they use a telehealth service. This is common practice for Teladoc, AmWell and other telemedicine services. It’s similar to the model of an urgent care center and it’s working for these companies. This model may or may not survive in the long run. That will be up to consumer patients to decide. Are patients willing to sacrifice familiarity and continuity of care for the sake of convenience?
At TelaPT, we see things a little differently. We value the connection between a patient and their practitioner. We believe that one of the cornerstones of success in Physical Therapy and Rehabilitation is the Therapeutic Alliance. The TA is “the relationship between a healthcare professional and a client. The Therapeutic Alliance is the means by which a therapist and a client hope to engage with each other, and effect beneficial change in the client.”
If you go to PT 2 or 3 times a week, you don’t want to see a different therapist every visit. We agree. Patients share some of their most personal information with their PT. In addition, TelePT can be even more comfortable than in-person care – TelePT visits are truly one-on-one and the patient is in the friendly confines of their own home.
“Every time a patient gets passed from one doctor to the next, there is a chance that critical information is lost.”
At TelaPT, each patient is assigned a Telehealth PT who manages the course of their care. You see the same PT every visit, or occasionally 1 other PT who is well-versed on you and your case by the managing PT. We firmly believe in the Therapeutic Alliance. Patients want to have someone they can trust and depend on for their care. In return, they will be more engaged and respond more positively when that connection is there. This is a very powerful connection and is one of the truly effective forces in the healing profession.
What makes a PT great?
Here are 2 examples from my past experience. One of the best technical PTs who every worked for me was not a people person. He found it difficult to comfortably connect with most patients and occasionally engaged in petty conflicts with patients and co-workers. Despite his stellar clinical credentials, his success with patients was less than average. On the other hand, the PT with the best results and the strongest following was a young lady who was technically average, but consistent. She was extremely compassionate and an excellent communicator. Most importantly, she connected with every patient and made sure they were on a mission of recovery together. If given the choice, I would hire her over him every time.
As my good friend Brian Gallagher of MEG Business Management once said to me, “I can teach a PT a new skill but I can’t teach them to be a good person.” Our TelePTs share our values and understand the merit of connecting with their patients, especially in a virtual environment. They all have DPT degrees and they are experts in musculoskeletal assessment and treatment. It goes without saying that they have the skills to help patients return to painfree activity. The TelePT difference is our commitment to connection.
The Pitfalls of Telehealth – and how to avoid them – Harvard Business Review 11/20/2020
“At the height of the Covid-19 pandemic, between 50% and 80% of medical visits were conducted via telemedicine, up from just 1% before it.” That number will likely settle around 20% by the end of 2021 and gradually increase over the next few decades as more patients and providers appreciate the effectiveness, convenience and flexibility. Now is the time to address some of the challenges of telehealth and develop our systems the right way.
Not every patient has the access and the digital literacy for telehealth.
UC San Diego Health medical students teach patients how to use telehealth platforms, check connectivity and generally troubleshoot telehealth access problems. At TelaPT, Physical Therapy students educate patients on how to log in to their first appointment on the Better PT platform. They teach them how to schedule an appointment and how to prepare for their first visit. We also offer a monthly training program with Q&A for new patients. We want every patient to have a positive TelePT experience.
Patients may feel disengaged by telehealth because they’re not in an office with other patients. Therefore, we have to go the extra mile to connect with our patients:
- We communicate with our patients via text and chat on our platform between visits.
- Every effort is made to customize the patient’s program to their environment. We safely train them to get out of their bed, get up from their low sofa and climb their stairs.
- We remotely monitor patient home exercise compliance and give them a nudge via secure text message if their compliance is not optimal.
- Family attendance is encouraged (with the patient’s consent), either from the same location as the patient or on a separate dial-in to the session.
- We encourage patients to participate weekly in remote group exercise programs specific to their condition:
- Chronic pain
Technology can lead to additional work for the practitioner.
We’ve spun that in the opposite direction. Our telehealth platform, BetterTelehealth, is integrated with our EMR, PromptEMR. So, when a patient schedules their first appointment with us, they get a link from Prompt to enter their intake information. Once completed, all of their entries populate directly into the provider’s note. This saves 10-15 minutes of documentation for the provider on every new patient. That can add up to 2.5 hours saved on documentation every week!
Integrating telehealth into daily operations has been a massive challenge for most traditional medical practices.
Physical therapy is no exception. TelaPT has solved that issue by only providing telehealth services. Every patient visit is remote. Every provider interaction is remote, so we built our entire infrastructure for telehealth and remote interactions. By doing this, we’ve made every phone call, every text, every video visit a very personal experience. To ensure engagement and success, we train everyone on the nuances of remote communication. It’s all we do. There’s no confusion about the expectations. Every patient interaction needs to be a positive one and the next one needs to be better. We live it.
The connection between patients and healthcare practitioners has been eroding for years. New models of care delivery address this lack of engagement and connection. Despite being in different physical locations, patients and providers connect intimately on a telehealth visit. At TelaPT we are focused on patient engagement and the Therapeutic Alliance in every patient experience. As a result, patients are engaged and outcomes are as good or better than in-office encounters.