Physicians can show empathy during an in-person visit with a reassuring hand on a patient’s shoulder or during a video visit by nodding at the right time or with facial expressions of concern. These options are not available during asynchronous message exchanges, but one expert says it is still possible for physicians to display “digital empathy.”
“Digital empathy is traditional empathic characteristics such as concern and caring for others expressed through computer-mediated communications,” according to Matthew Sakumoto, MD. He explored the concept in an AMA webinar and is chief medical information officer for Sutter West Bay Region in San Francisco.
Sutter Health is a member of the AMA Health System Program, which provides enterprise solutions to equip leadership, physicians and care teams with resources to help drive the future of medicine.
“People are concerned that doing care over video or doing care over messaging is a little difficult, but for me, it's really unlocked the ability to do chronic-care management,” said Dr. Sakumoto, a primary care physician, informaticist and self-described “virtualist.”
“I practice primarily telemedicine, both in the video-visit format as well as the messaging format,” he explained. “I also maintain a hybrid practice, so one day a week, I’m physically in clinic. I think it's important to see both patients and members of the care team—but the ‘virtualist’ part is doing primary care in a primarily virtual format.”
He described message-based chronic care management as “interstitial care,” meaning the “stuff between stuff,” which involves asynchronous patient check-ins, remote patient monitoring, reliance on patient-reported outcomes, and earlier interventions rather than episodic care.
“We're used to a very episodic-based thing where I see a patient to manage their diabetes today and follow up in three months, but there's not a lot that happens in the in-between,” he explained. “This is interstitial care. It's proactive, it's continuous.”
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Demonstrating digital empathy
Dr. Sakumoto’s presentation included a photo of a person caring for a bonsai tree, which he said illustrated “this idea that small, little nudges throughout and in between can have really big changes.”
It’s “creating more time through tech-enabled, team-based care,” Dr. Sakumoto said, adding that this extra time that’s created “makes up for that lack of physical touch that is missing when you can't do an in-person visit.”
A “productive” physician can see and document their work on 30 patients a day, he said. But, with the right infrastructure, a physician-led team-based “pod” can make a positive impact on up to 30 patients per hour.
To illustrate his point, Dr. Sakumoto showed a slide of a coffee mug displaying the classic office theme: This meeting could have been an email.
“Many times, this video visit could have been a message,” said Dr. Sakumoto in the webinar, which is available on demand.
4 steps to achieving digital empathy
Dr. Sakumoto also identified and explained the essential steps to achieving digital empathy.
Acknowledging the message promptly. “Acknowledging the receipt with an approximate ETA really, really makes a difference,” Dr. Sakumoto said. “Patients are wondering, did they see it? Or did they see it and they're just ignoring me?”
Often, a patient message may spur calls to a specialist or a lab and an immediate resolution isn’t forthcoming.
“We're doing a lot of work behind the scenes, but the patient doesn't realize it,” Dr. Sakumoto said, adding that a quick “Hey, we got your message” reply and an explanation of what is being done in response usually helps calm a concerned patient.
“A lot of times, they're anxious,” he said. “They're not really sure what this new symptom is or what their new lab value showed and why that's concerning or not clinically concerning.”
Personalize the communication. This is important in relationship- and rapport-building during early contacts with a patient.
“Adding a personal touch actually does make a difference,” Dr. Sakumoto said. “I think of it like the digital version of a handwritten thank-you note—and it's nice to get those every so often. So, at least during initial visits—particularly when I'm doing that rapport-building—I try to make it as personalized as possible.”
As noted in a paper that Dr. Sakumoto co-wrote that was published in Telehealth and Medicine Today, this can include referencing a patient’s health goals or displaying interest in their personal life such as trips or asking about their children.
Set clear and consistent expectations. This involves setting norms for response times across the care team and the organization. This includes providing guidance on the clinical appropriateness of what can and cannot be handled via message and that relaying some information may require a video or in-person visit.
Patients should know upfront that you usually will not resolve their question within seconds or even within hours. If a clinic has the capacity, it could be by the end of the day, but there could be instances where it takes three to five days.
“Setting those clear timelines and acknowledging receipt, that has helped to really knock down the amount of repeat messages that we'll get from patients,” Dr. Sakumoto said.
Recapturing the patient voice. Learn the story being told by the messages a patient sends to their doctor by turning text threads into patient narratives that reveal the evolution of a patient's journey.
“I'll be honest: I took long patient messages as a negative initially, but it's really a way to capture the patient's voice through this idea of narrative medicine,” Dr. Sakumoto said.
“It helps me think about: how do I treat this problem that the patient has?” he added. “Having those multiple, repeated interactions with a patient, you get a sense of why they are so worried about a clinical symptom that doesn't seem that worrisome—at least to me.”
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