Welcome to the world of live video

In increasing numbers, healthcare providers are becoming involved in clinical telemedicine programs without understanding how patients on the remote end are viewing them.

If you’ve Skyped or used Facetime to videoconference with a relative, it’s easy to convince yourself you know all there is to know about it.  You are probably familiar with the studies that have shown patients don’t always retain the important medical information you provide them. Part of this is due to distractions. (Squirrel!) My reason for writing this article is to suggest some subtle improvements on your end that would minimize distractions and allow patients to focus on what you are saying to them during telemedicine visits.

Let’s begin with the Web camera, the one in your laptop.  As I look at my laptop camera at the top of the monitor here on my desk, it is about eight inches below my eye level.  During a videoconference, the person on the other end would be “looking up” at me, and the background he or she sees will include the neon light fixtures in the office ceiling.  The angle is not only distracting, but it’s also downright unflattering.  You need to bring the top edge of your laptop to your eye level.  Fifteen years ago, I would have suggested using a couple of telephone directories, but who has those anymore!  Find some coffee table books and place them under the computer.  If you have a “dock,” you will either have to raise it as well or disconnect the laptop, at least during the visit.  If you are still using a standalone Web cam, make sure that it is right next to the monitor, or better yet, just above it.  Otherwise, patients may wonder if you’re really speaking to them because you seem to be looking away.

Those of you who depend on a tablet, please don’t hold it during the session with the patient.  You’ll end up looking down even more because you can’t keep it steady in front of you and at eye level.  Sudden, unsteady movements may also trigger patient nausea.

Privacy is very important.  Obviously, you should be in a closed room or office so someone doesn’t happen to walk behind you.  Sometimes the walls aren’t as thick as you think.  Put on a pair of headphones with your laptop microphone on and listen.  Are there any ambient noises that will be heard at the distant end?  What about that noisy airflow from the air conditioner?  Or the oscillating fan?  Is the white noise an issue?  Then stop the fan or turn up the temp temporarily.  Put your phone on mute because you don’t want to take a call during a patient session.  You wouldn’t do that during an in-person visit because it sends the wrong message.  And don’t set it on the desk with your laptop, especially if your phone vibrates when you get email.  It’s amazing how easily the microphone picks up the vibration sounds of an incoming call. 

One final pointer about audio you may not have considered.  Does your computer make a pinging sound when you receive an incoming email?  They’re helpful alerts, but they can really be annoying during a videoconference and may interrupt your train of thought.  If you have a Windows 7 computer, go to “Control Panel,” and select “Sound.”  In the box that appears, click on “Sounds” at the top.  Then scroll down to “New Mail Notification.”  Click on it to highlight it.  That allows you to browse the available “Sounds.”  You want to choose “None” and then click on “Apply” and “OK.”  For those with a MAC, open your “Outlook.”  Click on “Outlook” at the top left and then “Preferences.”  This is where you can find “Notifications and Sounds.”  Under “Sounds,” uncheck the box for email.  You can also uncheck all the boxes to make sure you don’t receive any audio notifications.  Finish by closing the “Notifications and Sounds” window to save the changes.

After taking care of the audio concerns, you need to focus on what the patient will be able to see.  Since you are a professional, the background needs to look professional. If there is a bookcase behind you, make sure the books are neatly displayed (Put that Coke can in the waste basket or out of view beforehand). Visual sloppiness is a definite no-no.  A plant directly behind you may look like it’s emanating from your head.  The best background is a wall painted a solid color with satin- or matte-finish paint.  The worst is a window or a framed photo with glass that reflects the ceiling lights.

This brings me to the location of your desk.  If there is a window behind you, bright daylight will either over-saturate the video the patient sees or close down the Web cam’s automatic iris and darken your face.  Neither is pretty.  If you are facing a window when looking at the monitor, a window might provide adequate lighting for you.  Generally, however, when dealing with overhead ceiling lights, you will need to use a desk lamp to remove the shadows your brows create.

If your desk is against a wall, all of the light will be behind you, and your head will be in the shadows.  Here you really need to use a desk lamp or lights that are specifically designed for videoconferencing.  Otherwise, it will look like you’re sitting in a closet.  You don’t want to depend on the light from the computer monitor which might give your face a blue tint.  Videoconferencing lights can be mounted on the monitor or placed at the sides to provide an even, warm light for flesh tones.  They can be pricey – between $125 and $265 if purchased online. You can find them by googling “videoconference lights.” 

If telemedicine is to be part of your practice and not just a one-time shot, the changes you make will be worth the investment in time and money.