Effect of telemedicine via videoconference on provider fatigue and empathy: Implications for the Quadruple Aim

Abstract

Telemedicine via videoconferencing rapidly deployed during the COVID-19 pandemic reduces contact and opportunity for virus transmission, with Quadruple Aim benefits of improved population health and associated cost avoidance of COVID-related illness. Patient experience of telemedicine has generally been positive, but widespread use of videoconferencing outside of healthcare has brought growing recognition of associated mental fatigue. Experience in telepsychiatry shows attending to non-verbal communication and maintaining empathic rapport requires increased mental effort, making provider experience more sensitive to cumulative fatigue effects. Since empathy and therapeutic alliance are foundational to all physician-patient relationships, these telepsychiatry findings have implications for telehealth generally. Health leaders and providers planning for sustainable incorporation of videoconferencing into ongoing healthcare delivery should consider the potential for unintended negative effects on provider experience and burnout.

Exploring Nurse and Patient Experiences of Developing Rapport During Oncology Ambulatory Care Videoconferencing Visits: Qualitative Descriptive Study

“…In a recent mixed methods study by Elsevier Health of 3000 nurses and doctors, over half of the clinicians felt telehealth would negatively impact their ability to demonstrate empathy and requested guidance on learning webside skills [51]. Although most of our participants felt able to transfer many bedside skills into VCVs, there is mixed evidence in the literature on whether videoconferencing can produce the same empathetic experience as an IPV [92]. Notable efforts have been made to provide guidance on a webside manner [26][27][28]93,94], but additional research is needed to ensure that professional development and practice guidelines are evidence based, and our findings provide data regarding relationship-based care and patient-centered communication in a videoconferencing environment.…”

“…Notable efforts have been made to provide guidance on a webside manner [26][27][28]93,94], but additional research is needed to ensure that professional development and practice guidelines are evidence based, and our findings provide data regarding relationship-based care and patient-centered communication in a videoconferencing environment. Schools of nursing and medicine need to prepare future practitioners to care for patients in a virtual health care environment, with competencies specific to these digital tools [92,95]. Fortunately, nursing theories [22,33,35] and conceptual models [96] exist to support this important work, and relationship-based care has been successfully incorporated into health care clinician curriculum and professional practice models [97,98], showing improvement in health care delivery [41,99,100].…”

“…For example, the lack of access to adequate devices and Wi-Fi resources for VCVs is well documented [1,103,104], but the impact of other factors, such as language barriers and availability of privacy and safe spaces for VCVs [105], require better understanding and accommodation. Specifically in relationship to rapport, there is some evidence that qualitative differences between type of device, strength of broadband, and level of literacy impact the level and quality of empathetic communication within VCVs [92]. Addressing these factors is essential if we are to avoid increasing the digital divide among populations who may already be at a higher risk for cancer due to social and economic disparities [106,107].…”

Health Communication Research Informs Inflammatory Bowel Disease Practice and Research: A Narrative Review

“… 73 Shortening the telehealth sessions could also reduce telehealth-associated clinician cognitive load and result in enhanced clinician empathy. 74 Clinicians are also advised to avoid using overly technical language when giving patients instructions regarding their care. 66 , 71 Clinicians should ensure the information and instructions they give are clear to the patient by checking the patient’s understanding.…”

Telemedicine use during the COVID-19 lockdown is associated with fewer depressive symptoms among physicians in private practice

“…However, some physicians reported increased satisfaction with tele-visits over in-person visits. In telepsychiatry, attending to non-verbal communication and maintaining empathy requires increased mental effort, making the provider experience more sensitive to cumulative fatigue effects [ 4 , 5 ].…”