Jan 19, 2021 6:07:40 PM
Is your practice thriving or struggling with telemedicine?
How well are you adapting to this environment of virtual care and remote communication with patients?
Successfully transitioning a practice to telemedicine depends to a large extent on the practitioner's ability to easily shift to between different communication styles and using that to establish rapport with new patients.
This was just one takeaway I got from a recent conversation with Stacie Deyglio, ND, a naturopathic physician in New York City who specializes in family medicine, chronic diseases, diet, lifestyle interventions, and science education.
Her practice has flourished throughout the pandemic, and she shared a few tips with us on Changing Healthcare. You can read the discussion below -- edited for length and readability -- or watch the whole interview on video.
Patrick: There is a lot of conversation out there right now about telemedicine and best practices. What is the biggest thing a lot of practitioners are just getting wrong?
Stacie: I think practitioners are expecting different results through telemedicine they are not seeing live, in real time. There is a lot of hesitation with telemedicine and the difficulty of not being able to communicate face-to-face, even though we really are talking -- but we are talking through a computer.
So, I think most practitioners find there is a challenge they have to get over. That’s number one. And number two, I think there is a hesitation to expand and adapt to meet the client's need.
Not everybody assimilates well into telemedicine, especially at first.
It takes a lot of patience, a lot of practice, and a lot of time to communicate well with them and find the path that works well on an individual basis.
Patrick: Yes, that makes sense. So, can you tell us a little bit about what your process is like? Did you practice telemedicine before the pandemic started?
Stacie: Not as much as I do now as a result of the pandemic. I started [practicing telemedicine] quite heavily in February and March of 2020. And I had to rapidly conform in order to survive.
I had a client base, and I needed to meet and reach these people. I needed to answer their questions. There was a large state of confusion at that time.
So, I developed a whole way of communicating with everyone on an individual basis, if necessary, or through blast emails or Google forms. I had to make them aware about how we are proceeding, because we have to adhere to the guidelines, and we all have to stay safe.
The adaptation that happened so rapidly at the start of the pandemic really was what kind of paved the way for what I am doing now.
See our interview with Stacie Deyglio on Changing Healthcare:
Patrick: And so can you tell us a little bit more about the process? It sounds like there is an intake form for the people. And then what happens after that?
Stacie: Sure. Everyone who comes in to see me has to complete an intake form. It's rather long -- anywhere between 14 and 20 pages depending on what their chief complaint is and what they want me to address.
I did not need established clients to do that, because they had already done it prior. So, we just kind of moved forward with meeting on a consistent basis. We had weekly check-ins. We were up at different hours of the day making appointments. If it worked better for them to meet at five a.m., then I was up at five a.m. meeting them and having a private conversation.
There is a large degree of flexibility with patients who are already established.
New clients had to complete the full intake. And then, we went through the same process that I would if they were sitting physically face-to-face with me. We had a very long conversation for the first consult, up to an hour and a half or two hours, and then 45 minutes for the next consult.
Once they were established, we could just do something very simple like a weekly check-in, or a Google form, or some type of text message or way of communicating. Some of them filled out a questionnaire I made, and they clicked the answers in a multiple choice system.
I was always able to communicate with them, but I adapted to a more virtual process of communicating.
Patrick: Yes. That brings up another interesting point. We are all experiencing Zoom fatigue right now.
You have that initial consultation, and it sounds like there are a number of scheduled follow-ups. There is just so much noise in everyone's schedule in terms of video chats on Zoom and things like that.
How do you really maintain a strong personal human connection with somebody? How do you rise above the noise and really maintain that virtually?
Stacie: That is a great question. I have always been able to establish rapport with a client that supersedes all the anxiety that they are dealing with. You really have to be very honest and very present with them.
Building rapport is one of the foundations to making this a successful endeavor and using humor to put everyone at ease. We are all going through the same process [in the pandemic]. We are all going through it individually, distinctly, and differently.
And everyone has their own struggles they are experiencing.
We need to be present with those people as well as focus on solutions to, like you said, rise above this and to make it better, so we can move into healing which is where we need to be.
Patrick: It is easy to see how personable you are. You speak to people really naturally. I am sure that, in a sense, the pandemic has almost made ND's like you even more accessible to people, because we are all going through the same experience, right?
This is life-changing for all of us. In a lot of ways, it probably helps you connect with patients on that level, right?
Stacie: Right. Yes. And I think it actually allowed me to draw even closer to them and to be more cognizant of what their needs were, especially when communicating in this form.
Some elderly patients do not adapt very well to telemedicine, so we had to navigate that. You really have to be flexible and open-minded. You cannot assume nor demand that the client is going to adapt to the method you have established. You really have to meet their needs and also anticipate what their needs will be.
For example, if I have a client who may not answer my phone calls or may not meet me in Zoom meetings, how am I going to approach this? How am I going to expand this relationship and make it successful for them? I am really here to serve their needs, and they are coming to me for that reason.
So, the conversation you establish and the rapport that you build with them at the onset of the relationship is most powerful, because it allows you to really interpret a lot about what that patient needs and then be open minded and establish flexibility.
Let us say if this person wants a weekly check-in, maybe text message works best for them, or an email works best, or the Google form. If they do not want to see me on a Zoom for a private, one-on-one conversation, well, then we have to do something different. We can have a phone call.
You have to remember to protect yourself and at the same time meet and anticipate their needs.
Patrick: Now, you bring up such an important point here where different people have different communication preferences. But it sounds like consistency is really the cornerstone of this, right? You need to really establish a precedent and make sure that you are meeting often enough to make sure they are hitting their health goals. How do you manage that with so many different forms of communication?
Stacie: I manage it through a calendar system. I have everything set it up in advance. I also have an email blast system and then a full system of communicating. Some clients will only use a Google form. It works best for them.
And I say to myself, "Okay. Well, what form of communication works best? How can we best serve their need?" Then I assign everyone a category they fit in. That is how I proceed.
So I check in with everyone at least twice a month. That is really important to do, because then you can see how you are going to move forward and what supplements need to be repurchased, or whether they need a referral for an issue that needs attention somewhere else. Just checking in on how they are doing really.
"You really have to be flexible and open-minded with telemedicine. You cannot assume the client is going to adapt to your methods. You really have to meet their needs and anticipate what their needs will be." - Stacie Deyglio, ND
Patrick: You just brought up supplements, which is another important piece of this, making sure patients are getting the nutrients that they need. How are you managing patient compliance? Are you relying exclusively on virtual dispensaries right now?
Stacie: I am at the present moment. I had a big shift from managing supplements in-house in my own dispensary to moving to the virtual dispensaries, because those are what work best right now.
I find that there has been a significant dip in patient compliance, maybe ten or fifteen percent. And I think it is a result of the adaptation process. People are now receiving [supplements] in the mail and missing that whole social component of coming in and the warmth and communication they would receive if they saw me physically.
So, I think that is where the dip comes from. I am looking for solutions about how to circumvent that, even if it means I have to [create] my own virtual dispensary, purchase supplements, and ship them out.
I am exploring options. I do not necessarily know if that would be worth my while right now. But I would like for all of my patients to be as compliant as they should be, because these recommendations are being made for their best interest.
Patrick: It has a big impact on results, right?
Stacie: Absolutely. Yes.
Patrick: And it is a little bit harder to stay on top of all that when there is another third-party app involved. There is something missing there.
Stacie: Yes. It is like having a teenager and then having to remind them to put deodorant on and brush their teeth and clean up their room, because they got--
Patrick: Deodorant is important.
Stacie: Yes [laughing]. That nagging issue has transformed into getting nutrients you need.
Patrick: Very true. I am also curious about practitioners that need to do physical examinations. There are only about 15 states in the country that license naturopaths to do physical exams. What are you hearing from other physicians about virtual care? How are they managing that piece?
Stacie: They are still seeing patients in a face-to-face format when they have a new patient. but they are slowing down quite a lot.
I do not know if they are seeing as many patients, because any patient who would need a physical exam on must fit into those limited brackets where you have to wear a mask, you have to call fifteen minutes before, you have to come alone, you have to come only during certain time frames. If it is a child or an elderly person, you would come with only one other person like a caregiver, and sanitize your hands.
All of the compliance issues slow everything down. I have heard they are able to do it, just at a slower pace.
Patrick: Okay. It sounds like you have really come a long way with virtual care. What is the aspect of it that is the most challenging for you at this point?
Stacie: There isn’t enough hours in the day for me to do everything I need to do to meet all the needs of the clients, maybe if I had a clone [laughs].
But I think that we are all navigating and adapting to it. I actually see this as kind of branching out. It has given me the opportunity to meet my clients on a much more intimate basis, because they feel the connection. Then, they have time carved out for themselves to sit and talk about the issues they are struggling with and want resolved, too.
Patrick: Are you accepting patients from outside the Greater New York City area? What is the story there?
Stacie: Yes. Absolutely. I see many clients that are not in this state or not in the country. Almost everyone who comes to me is through word of mouth. Yes.
Patrick: Give us an example? Where does your most distant patient live?
Stacie: Oh, I have a few clients in Canada. And I have a client in the UK.
Patrick: That is so cool. All right. So, if somebody did want to learn a little bit more about you, how would someone go about that?
Stacie: They can contact me through LinkedIn. And I am on Facebook. And I am sure, through this information available here.
Patrick: We will be sure to include some links in the notes as well so that people can track you down and learn more about the great things that you are doing.
Stacie: Thank you so much. Thank you so much. I appreciate it.
Patrick: Stacie, I cannot thank you enough for joining us today. This is really valuable information. And I know that a lot of practitioners are really struggling with this. So I am sure it will help them a lot.
Stacie: Absolutely. I would only encourage them to be as flexible and as open-minded as possible. It will be to your own success.