Latest / Off the Chart: A Business of Medicine Podcast / S1 Ep135: The promises and limits of virtual care, with Sarah Matt, M.D., MBA
Transcript
- 0:00 I would suggest that access to strong, consistent Wi Fi is almost a social determinant of health, and it needs to be considered a utility at this point, people who don't have access to the internet in a reliable fashion with unlimited data don't have the best bet of getting great health care in 2026 0:22 you business of medicine podcast featuring lively and informative conversations with healthcare experts, opinion leaders and practicing physicians about the challenges facing doctors and medical practices. My name is Austin Luttrell. I'm the associate editor of medical economics. I'd like to thank you for joining. Like to thank you for joining us today in today's episode at medical economics, managing editor Todd shriox at downward doctor, Sarah Matt, a practicing physician, Health Technology Strategist, author of The borderless healthcare revolution and a recent addition to the medical economics editorial board. They're talking about how virtual care has reshaped the patient physician relationship since this covid 19 pandemic, and what's actually at stake when Carrie moves to a screen. Dr, Sarah, Matt, thank you again for joining us, and now let's get into the 1:17 episode. Dr, Matt, thanks for joining me. Well, 1:20 thanks for having me today, excited to be here. 1:23 So to set the stage, how is the rapid expansion of virtual care kind of changed the way the clinicians interact with patients compared with traditional in person visits. So it 1:35 really depends on the practice and specialty. But what I'd say is that since the time of covid, as you mentioned, virtual care has been expanded exponential rate, but it really depends on what kinds of doctors are seeing what kinds of patients. So for some physicians, they're only doing telemedicine practices. And so a lot of this is with women's health, primary care, urgent care visits, and again, that's a 100% virtual experience, and those patients will never see their provider in person. On the other hand, a lot of providers that were only doing in person visits are now having more of a hybrid approach. So they'll have specific office hours where they're seeing patients via televisions, or they'll be doing remote patient monitoring or other pieces, and that will constitute that hybrid experience where their patients will actually see them as well in person, 2:24 many physicians worry that something's lost when care moves onto a screen. From your perspective, what aspects of the patient physician relationship are most at risk in remote encounters? 2:37 I'd say that it's more difficult to get a full picture of a patient when you can only see their face, and when you see a full patient in person, you get a really good idea of what's going on in their life. What have they brought with them to the appointment? Who have they brought with them to the appointment? What are they wearing? Sometimes on a virtual visit, you can only see their face and a blurred background, so it's difficult to get all those context cues at the same time, it's hard for your patient to get context cues about you. As an example, I am so tall on Zoom, but I am not in person, and so when a provider and patient make that relationship, they're looking each other up. They're trying to figure out who each other is based on those cues, and sometimes it makes the relationship harder to make 3:22 what specific techniques or behaviors have you seen doctors use successfully to build trust and rapport with patients during a virtual visit? 3:32 I think they're the same as a regular visit. You know, digital empathy and in person empathy are vitally important. Just because we have technology in the middle doesn't mean we can't produce a relationship. So as an example, Todd, we've met for the first time just recently, and I feel like I can give you a call, no problem, and it just depends on that rapport we bring back and forth. So instead of just checking all the boxes during a visit, whether you're in the office or on the computer, make a relationship, the small talk is important. Understanding that you're listening is important. And whether that's you face to face with the patient in your office or you over a tele visit, I think that they both vitally matter. 4:12 How important is preparation on the doctor's side, such as reviewing records, setting expectations or managing the virtual environment to making remote visits feel more personal. 4:25 So it's really difficult. You have to remember that doctors are people too, and they are actually being pushed into an environment where the docs have to see a certain number of patients every day. They don't have nearly as much prep time as they would like, whether it's in person or virtual. They don't have nearly as much control over their environment. In person or technically, as you would like to as a doc. So I think it's important to do what you can to prepare, but you'll have to remember that in a regular practice setting, most physicians will be essentially looking at the chart right before they go in and see the patient. Some people are very lucky the patient. In the other specialty, to be able to review them the night before or early that morning. But it really depends on the specialty. So for the best visits, everyone needs to be prepared the patient and the provider. And for the best visits, it needs to be a clean and welcoming environment so that everyone can have a great discussion and feel open and have that trust built. 5:21 Are there particular patient populations or certain scenarios where virtual visits can actually enhance communication or engagement compared with an in office visit? 5:32 That's an interesting thought process. And Todd, I will tell you the answer is yes. So it's interesting. During covid, they use a lot of, we'll say virtual discharge nurses, even within hospitals. And what was found during those studies was that older adults actually found that looking at an iPad was a lot easier for them, because they could turn the volume up. They could read lips. Sometimes they could use a transcription because they didn't quite understand the words that were coming out of their mouths. So I'd say there's lots of different scenarios where having those other cues and abilities to communicate are really helpful. We forget that even in person, sometimes it's hard to concentrate based on the environment. Sometimes it's hard to remember everything. And when you're in a virtual environment, I can have my list right here on my desk as I'm talking to my doctor, I can also, you know, take a deep breath on mute. There's no mute button when you're in person. And so I'd say there's absolutely lots of reasons. And the other one is that I didn't have to drive to your office today. I didn't have the stress of commuting. I didn't have the stress of having to bring my kids to daycare, all those different pieces that I think we don't necessarily think about in a minute to minute basis, but it really matters the patient 6:47 shifting to equity. What role do you see virtual care playing in addressing the long standing disparities that we see in access to health services? 6:57 We don't have enough time for that whole conversation Todd. But what I would say is that when you think about telemedicine, virtual visits, digital health, I'm hopeful that will bring the basement of care up so that more people, whether they're in urban settings, rural, in whatever economic category, you name it, all patients, should be able to get a better access than they had before. So whether you're a block away from a doctor's office or a gazillion miles away, hopefully virtual care report, remote patient monitoring, and the other tools that we're bringing to bear will assist you in finding new ways to get the care that you need. However, I will say that there is an ever increasing visualization here on the fact that not necessarily everyone has access to those tools. So whether you are urban poor or in a deeply rural environment, the infrastructure may be lacking. I would suggest that access to strong, consistent Wi Fi is almost a social determinant of health, and it needs to be considered a utility at this point. People who don't have access to the internet in a reliable fashion, with unlimited data, don't have the best bet of getting great health care in 2026 8:13 Yeah, I was going to ask about that, because having access or the ability to do a virtual visit is one thing, but if you don't, have the actual you don't have the computer, you don't have the bandwidth, you know, that's a whole nother level of barrier that we have to figure out a way to overcome. 8:31 So I used an interesting analogy in a talk I gave yesterday. You know, I'm in upstate New York. We get a ton of snow, and even if you have an amazing virtual platform, and you can have remote patient monitoring, a telehealth visit, all the things someone who lives on a really long road up a big, steep hill in the middle of a snowstorm. It doesn't matter how great your AI is. It doesn't matter how great your platform if the road goes unshaveled And you can't get an ambulance to someone who needs it. So there's lots of different barriers that are beyond the technology that we really have to consider, 9:06 is there something individual doctors can do to help their patients reduce these barriers and get the care that they need? 9:17 I'd say it's difficult for individual doctors. A system approach is really necessary, I'd say that anything a individual provider can do to remain open to communication with their patient, whether it's phone or message, telehealth or in person, the better at the same time, providers need to protect their own well being as well, because a burnt out physician is taking care of no one, whereas a provider that has a strong, stable foundation can help move things forward in the future. 9:57 Hey there. Keith Reynolds here and welcome to the p2 managed. Minute in just 60 seconds, we deliver proven, real world tactics you can plug into your practice today, whether that means speeding up check in, lifting staff morale or nudging patient satisfaction north. No theory, no fluff, just the kind of guidance that fits between appointments and moves the needle before lunch. But the best ideas don't all come from our newsroom. They come from you got a clever workflow, hack an employee engagement win, or a lesson learned the hard way. I want to feature it. Shoot me an email at K Reynolds at mjh life sciences.com with your topic, quick outline or even a smartphone clip. We'll handle the rest and get your insights in front of your peers nationwide. Let's make every minute count together. Thanks for watching, and I'll see you in the next p2 management minute. 10:47 How does digital digital literacy on both the patient and doctor side, factor into whether virtual care helps or harms equity? 10:56 There's lots of different things that could increase the disparities in care. What I would say is that from a digital health perspective, if we think about patients, first, some patients use digital health, use digital tools, use AI every day, and we're seeing a lot of younger generations being able to pick it up a lot quicker. The provider space is not that much different. So when I went to med school, they gave me a palm pilot, and we thought it was magical. It was, you know, the best technology at the time. And today, I'd say we're in one of the first generations where the most senior providers may not be able to give the best advice to new graduates and trainees about how to use the technology the best, because they may not be as agile with it as some of our new grads, so there's definitely a learning curve for everyone. But I would suggest that this just means that in our communities, we need to lean on people from all generations and different kinds of people. So whether you're teaching people how to use the internet at the library or putting up a pop up in a grocery store or a church, figuring out how to bring people from different parts of life, different ages, different everything is going to be helpful because they have different thought processes and different expertise. The same is true in the healthcare side on the delivery part of the business healthcare is not just our senior leaders making all the best decisions. It's about bringing the expertise from all levels, whether that's doctors, nurses, Ma's as well as med students and trainees and our most senior providers too. 12:32 So what responsibilities do physicians have to adapt their communication styles or workflows to meet patients where they are, technologically or culturally. 12:44 It's hard to put all the responsibility on the provider as an individual, because you have to remember that most providers are working within a large system, and a large healthcare system has dictated the electronic medical record that's being used, the technology that's being used, et cetera. So to put the onus directly on a physician is a difficult one, because we are putting a lot of things on the provider. Not only do they have to take care of a patient with amazing hospitality and experience, but they have to stay completely up to date on all the medical literature and and and so instead, what I would suggest is that healthcare systems need to be responsible for enabling their providers to give a great experience, enable their providers to use things that are not so complex that it takes away from care. 13:32 Looking ahead, what design choices in virtual care platforms or care models are most critical to ensuring that remote care truly supports equitable, patient centered care, 13:45 I think the trick here is that people forget, whether they're in the tech side and vendors or in the healthcare delivery space and leadership, that it really doesn't matter what they think is the right thing to do. They have to actually ask the patients. And so whether we are addressing the needs of rural farmers, urban folks that take the bus, refugees that don't speak English, whoever it is, if you're trying to solve problems on behalf of that group, you should be including members of that group into your advisory boards. Otherwise, you are literally flying blind. So instead of just assuming you know what's best for everyone, ask the people who are going to be impacted the most. 14:27 Yeah, I think we've all seen technology that was obviously never tested with the people that were actually going to use it. 14:35 And I would argue that sometimes our healthcare policies and the way that we deliver care also helps with billing codes or helps with schedules, but it may not help a patient actually get the care they need. So it's not just the tech, it's the whole surround. 14:51 If you could give physicians one guiding principle for using virtual care to strengthen patient relationships while reducing disparities. What would it be? 15:02 Be flexible. Some patients are going to do great with virtual care, and some won't. It's not a one size fits all, and it's not a one size fits all for you too. Some providers are going to find they get great results and experiences for themselves with patients, and others are going to find it's just not working really well for them. So be flexible and understand where it meets needs for patients and meets needs for the provider too. 15:25 Is there anything else that you would like to mention that we haven't talked about so I 15:30 spent a lot of time this past year writing my book, The borderless healthcare revolution. It's a national bestseller, and for me, it's a blueprint on how to bring access to bear in the American healthcare system. In particular, I wrote it so that we could bring better access to everyone, no matter who you are listening to this today, everyone has a terrible access story. So I'd encourage everyone to read that roadmap and think about what's the one thing they could do to improve access today. 15:57 Very good. Doc. Thanks for joining me. Thanks for having me. Todd, I appreciate it. Once again. That was 16:11 Dr Sarah Matt. She was talking with medical economics Managing Editor Todd schryock, on behalf of the whole medical economics and physicians practice teams, I'd like to thank you for listening to the show and ask that you please subscribe so you don't miss the next step in episode. As always, be sure to check back on Monday and Thursday mornings for the latest conversations with experts, sharing strategies, stories and solutions for your practice. You can find us by searching off the chart wherever you get your podcasts. Also, if you like the best stories that medical economics and physicians practice published delivered straight to your email six days of the week, subscribe to our newsletters at medical economics.com and physicianspractice.com off the chart, a business and medicine podcast is executive produced by Chris mazzolini and Keith Reynolds and produced by Austin Latrell. Medical economics and physicians practice are both members of the mjh Life Sciences family. Thank you.