NHPCO NewsLine Summer 2020 - 14

continued

Helpful Tips
A couple of tips for effective
telehealth visits involves
monitoring your own behavior:
How do I look? Am I engaged?
What is my body language
saying? A little bit of selfconsciousness could work in our
favor and make us more tuned in
on what are we saying, not just
verbally, but non-verbally.
We should think about boundaries
when we think about the virtual
visit. Having a sense of how much
time we are going to spend, how
that time will be spent, setting
good expectations, getting the
patients' and caregivers' consents
for what you are going to discuss
are all things to think about.
With telehealth, compared to a
physician's office visit, it is neutral
ground that can have a
humanizing effect. We see the
patient in their own home, in their
native setting where they belong.
Additionally, you get many clues by
seeing how they interact with their
family. It gives the family or the
caregivers a bigger role than they
have if they come along to the
physician's office and it can have
that leveling effect of putting
everyone on the same page.
We do need to realize that a visit
sometimes needs to be in person,
but we should know why this is
required. Is it because we need to
do a physical exam that we cannot
do through visual inspection?
Home visits are always going to be
necessary, but sometimes, we can
do it just as well or even better
through telehealth.

14

Newsline / Summer 2020

Michael Fratkin, MD
Michael Fratkin is Founder and
Medical Director of Resolution
Care Network.
I am Michael Fratkin, and I am a
father and a husband and a
bunch of other things as well as a
palliative care provider living far,
far, far in Northern California up
in Humble County, about six
hours north of the San Francisco
Bay area. I built Resolution Care
Network, a home-based palliative
care program on the basis of
burnout. I imagine that some of
you understand the nature of
having not enough resources to
do what is there to be done in
your communities.
I built a Resolution Care Network
utilizing this principle that telehealth or telecommunications can
connect us to people in their
homes and that we don't have to
take people out of their homes
and put them into clinical
environments in order to enhance
their quality of life.
In fact, my kind of guiding

principle is that telemedicine is
better than real life. The ways
that I think it's better than real
life is that there are some
practical concerns. The issues
related to getting to my office, for
a very seriously ill person and
probably their daughter, taking
time off from work, getting put
together in the morning and
dressed and showered and
organized, and into the car with
their walker, their wheelchair, or
whatever devices. They have to
drive maybe 10 minutes to a
clinical environment - in my
environment, three hours - to sit
in a waiting room where there are
10-year-old People Magazines
and the clipboard shoved in your
face, again, for the fourth time in
the last month. And you listen to
that environment and notice the
sounds and smells and differences
of the people around you, and you
have people coughing which has
always been a struggle but now is
certainly different, the risk and
threat to the wellbeing and
safety, to be put back into an
exam room and, without windows
with some diagram of the sinuses
on the wall while you sit there
twiddling your thumbs, waiting
for the doctor to come in 20
minutes late and then to be
interacting with you like this. Then
reversing the whole thing to get
home again, all in the interest of
improving quality of life.
Those are practical
considerations, but there are
some more nuanced
considerations that by creating a
frame around a home visit that
we can enter the space that a
NHPCO NewsLine Summer 2020

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