The Teleconsultation Process

In addition to the requirements listed above, when setting up a real time teleconsultation, there are key considerations that need to be addressed to ensure an optimal experience. The closer the teleconsultation process is able to simulate face-to-face interaction, the more positive the experience for both the clinician and the patient.

1. Placement of the Video Monitor

• Optimal position is with video monitors and cameras placed four feet in front of the patient and at eye level
• Clinician’s upper body should be fully visible
• Environment should foster comfort and trust by being clean, adequately lit and free from clutter
• Interactions should take place in a controlled environment to promote patient privacy (Jarvis-Selinger et al., 2008)
• Informed consent should include a discussion of possible limitations to patient confidentiality
• Patient requires an explanation of the equipment and procedures (Jarvis-Selinger et al., 2008)

2. Organizational challenges for the set up of teleconsultation systems

• Coordinating and scheduling various practitioners involved in virtual care
• Development of protocols for using the system
• Provision of training
• Availability and maintenance of equipment
• Clear roles, responsibilities and protocols will assist organization and avoid challenges associated with the set up and delivery of teleconsultation sessions
• User satisfaction and confidence with the system will be enhanced with efficient set up and use of teleconsultation systems

3. Eye contact

• Eye contact is a critical element in the development of a patient/clinician relationship
• Patients surveyed indicated that eye contact by the clinician was an important part of communication and interaction
• The better and more frequent the eye contact, the greater the participant satisfaction
• The closer you sit to the viewing screen, the larger the angle of eye gaze (see picture)
• The clinician looks directly at the monitor in order to assess the patient; however, the video camera is most often located on the top of the screen

(Source: Tam, T., Cafazzo, J.A., Seto, E., Salenieks, M.E. & Rossos, P.G.(2006). Perception of eye contact in video teleconsultation. Journal of Telemedicine and Telecare, 13(1), 38.)

The picture below illustrates how eye contact can be misdirected during teleconsultation. The first image displays the clinician looking at the camera, while in the second image the clinician is looking at the monitor.

Look at image (a). How would you describe the clinician?
Look at image (b). Does your impression change? Now how would you describe the clinician?

(Source: Tam, T., Cafazzo, J.A., Seto, E., Salenieks, M.E. & Rossos, P.G. (2006). Perception of eye contact in video teleconsultation. Journal of Telemedicine and Telecare, 13(1), 37. )

• Indirect eye contact can be perceived as a lack of interest in the patient and conversation.
• Participants described the clinician in image (b) as: reserved, shy, bored, untrustworthy and depressed (Tam et al., 2006).
• Improved eye contact can be attained by moving a distance away from the monitor.
• Ideally the camera should be placed in the centre of the screen to capture direct eye contact.