Telehealth Best Practices: Dr Marta T. Becker of My Journal Health On How To Best Care For Your Patients When They Are Not Physically In Front Of You

One of the consequences of the pandemic is the dramatic growth of Telehealth and Telemedicine. But how can doctors and providers best care for their patients when they are not physically in front of them? What do doctors wish patients knew in order to make sure they are getting the best results even though they are not actually in the office? How can Telehealth approximate and even improve upon the healthcare that traditional doctors’ visits can provide?

In this interview series, called “Telehealth Best Practices; How To Best Care For Your Patients When They Are Not Physically In Front Of You” we are talking to successful Doctors, Dentists, Psychotherapists, Counselors, and other medical and wellness professionals who share lessons and stories from their experience about the best practices in Telehealth. As a part of this series, Dave Philistin had the pleasure of interviewing Marta T. Becker.

Marta T. Becker, MD is the Chief Medical Officer of My Journal Health, a mobile app that helps those suffering with chronic conditions capture and tell their health story, leading to better health outcomes. Dr. Becker is also a board-certified otolaryngologist-Head and Neck surgeon in private practice in the Philadelphia area. She graduated from Harvard University and the Harvard-MIT Health Sciences and Technology (HST) division of Harvard Medical School and was residency-trained at the University of North Carolina at Chapel Hill. She is a partner at the single-specialty practice Berger Henry ENT Specialty Group. She is passionate about using digital tools and the internet to help improve patients’ healthcare experience and outcomes.

Dave Philistin: Thank you so much for joining us in this interview series! Before we dive in, our readers would love to “get to know you” a bit better. Can you tell us a bit about your ‘backstory’ and how you got started?

Dr. Marta Becker: I have wanted to be a surgeon since I was very young. I was drawn to science and always found myself wanting to fix things. I found my way to the ENT (ear, nose, and throat) specialty because of the intricacies of the head and the neck. The interesting functions of the head and the neck are tied to the broader spectrum of whole-patient care, and I liked that I could treat the core human system both medically and surgically, rather than one or the other.

ENT can be one of the lesser known medical specialties, but I’ve found that many people eventually need one. I encounter people at every stage of their life — from newborns to the elderly. My oldest patient was 106!

In the 20 years that I’ve been an ENT specialist, I’ve been surprised at how little the facts change: the diagnoses and the medical aspects involved in this field generally don’t fluctuate much. I always keep up with the latest research, but I find that it’s much more difficult to navigate my patients’ anxieties, expectations, and emotions than it is to diagnose a specific problem. You never know what to expect when you open the examination room door. It is constantly changing terrain, and I find it endlessly interesting and challenging.

As I’ve grown in my career — especially in today’s environment with the stresses on our healthcare system — I’ve continued to think about how to enhance patient care and support. It matters to me that we keep trying to get people better care, and that includes considering how technology can help. I am passionate about using video, teleconferencing, algorithmic models, and computers to augment how we support patients. For example, can we integrate data from research and studies into critical care guidelines? This can sound impersonal, but I think it will help people receive more quality, uniform care, rather than rely on any one practitioner’s biases or treatment trends.

DP: Can you share the most interesting story that happened to you since you began your career?

Dr. MB: It is difficult to pick just one. The case of a patient who was feeling dizzy comes top of mind. With dizziness as a symptom, it’s very important to get at the specific details of how it all started — when it happened, how long it’s been happening, what triggered it, and the like.

As this elderly patient was describing their symptoms, they explained that it felt as if the ground was constantly moving beneath them, like they were perpetually on a boat. It became clear that this begam soon after their partner died, I realized that for this person, the symptom was very much a psychologically-based, brain-generated symptom of anxiety or unease about how they would go forward in the world.

It’s one of the most poignant examples of how our bodies can express things for us based on what’s going on in our lives. I think it happens more than people might recognize, and it points to the importance of getting at the root of certain symptoms, particularly in the ENT field.

DP: Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?

Dr. MB: My late father-in-law was a preeminent federal judge. He said something that he credits to his Latin teacher in his boyhood, who said, “If you’re in doubt, you should do it the right way.”

That may seem obvious, but it’s easier said than done. When you’re faced with a difficult decision, you have to weigh important factors: will something be more difficult, more expensive, or more time-consuming if done the “right” way? If you’re really on the fence and you have the opportunity to do something the best way you know how to do it — that’s the answer.

I often find this advice helpful with clinical decision-making. If I really stop and search my gut — even if the answer isn’t the easiest one for my patient or for me — it helps clarify the situation.

DP: None of us are able to achieve success without some help along the way. Is there a particular person who you are grateful towards who helped get you to where you are? Can you share a story about that?

Dr. MB: One of the people I’m most grateful to in my life is one of my teachers from medical school. Her name is Jo Shapiro, MD, an otolaryngologist who works in Boston. When I was a medical student, she was a part-time, well respected doctor and a working mother.

She was the kind of person who gave me a glimpse of who I could be some day. I thought, “I can be that person — that’s a life I would want.” To me, it seemed like Jo had perfected the model for balancing a personal life with a successful career.

She paved a path for women in otolaryngology when there weren’t very many of us in this field. There are still not many female ENTs, but there are more than there used to be. I am grateful for the women who came before me, like Jo. I hope I can build on their example.

DP: Ok wonderful. Let’s now shift to the main focus of our interview. The pandemic has changed so many things about the way we behave. One of them of course, is how doctors treat their patients. Many doctors have started treating their patients remotely. Telehealth can of course be very different than working with a patient that is in front of you. This provides great opportunity because it allows more people access to medical professionals, but it can also create unique challenges. To begin, can you articulate for our readers a few of the main benefits of having a patient in front of you?

Dr. MB: Clearly, the pandemic has changed life enormously for everybody — from patients to every type of doctor. It has forced us to change the way we do things, and remote treatment became a necessity. I think there are several benefits to telehealth.

Primarily telehealth saves people time and travel. We, as physicians, can serve more patients if travel or distance is no longer a requirement. Telehealth also makes it easier to manage time with patients. For instance, if I’ve set 15 minutes for a telehealth visit, it’s very clear when that time is up. I tend not to run late, and things are more structured in virtual visits.

With telehealth, your video chat can be structured to get the patient the most amount of attention and the most information possible in your allotted time. During in-person visits, you can easily spend a lot of time looking up a patient’s medication list or looking through their medical history while they’re talking about their symptoms. That’s not the best use of the patient’s time or mine.

There’s a lot you can do just as well with telehealth as you can in-person, and I think it’s been a useful alternative.

DP: On the flip side, can you articulate for our readers a few of the main challenges that arise when a patient is not in the same space as the doctor?

Dr. MB: The benefit of having a patient in front of you is that you can examine them physically. You can look in their ears and their mouth and listen to their chest or touch other parts of their body. This is the key challenge with telehealth.

Beyond that, I find that an empathic connection is enhanced during in-person visits. Virtual visits can create distance from the patient, framing their case as a medical question not an emotional plea. While it is wonderful to establish genuine connections with your patients, as clinicians it behooves us to be as objective as possible. It is important for physicians to be mindful of this new dynamic.

In the end, I prefer to see people in-person. We can interact in a more natural way and I can conduct a better examination, which is critical for things like ear pain, which is difficult to assess virtually.

DP: Fantastic. Here is the main question of our interview. Based on your experience, what can one do to address or redress each of those challenges? What are your “5 Things You Need To Know To Best Care For Your Patients When They Are Not Physically In Front Of You ?

Dr. MB: There are broadly five main challenges during any doctor-patient visit, but the following especially apply to telehealth visits:

  1. Understanding prior treatments and their effects. It’s important for patients to be able to share what treatments they’ve tried — from over-the-counter medication to sleep and exercise — and how it affected them. It’s always key to understand when something started, what has helped, and what has not helped.
  2. Using digital tools to capture symptoms. It can be difficult to understand a patient’s symptoms if they are fleeting or sporadic. I’ve seen success with patients taking cellphone photos of physical symptoms as they come up, and then we can review them together. It’s helpful for me to have a visual of the active symptom so I can fully understand what they’re describing. Technology can address this challenge by helping capture and document symptoms that come and go.
  3. Having an agenda. Understanding what patients want to get out of the visit is key. It’s also important to have realistic expectations based on the amount of time the patient has with the doctor, so the doctor can structure the visit appropriately. As long as everyone knows what the agenda is, time can be budgeted or a second appointment can be made.
  4. Making a connection. As I previously mentioned, doctors’ ability to make a genuine connection with their patient is important, and it’s challenging in a virtual setting. This is more of a challenge for doctors, who need to adapt their personal style and patient visit approach to ensure they’re able to deliver the best results possible for their patients, no matter the setting.
  5. Staying resourceful, even if you’re not meeting physically. For specialists like ENTs who do their best work when they can physically examine their patient, being resourceful during virtual visits goes a long way. For example, I’ve been able to diagnose tonsillitis virtually because a patient did a great job at showing me their throat and giving me all the information I needed over the computer.

DP: Can you share a few ways that Telehealth can create opportunities or benefits that traditional in-office visits cannot provide? Can you please share a story or give an example?

Dr. MB: I think telehealth has created significant opportunities in the field of medicine, especially in terms of how it’s changed the doctor visit. I’ve done telehealth visits with patients who have been on vacation in another state — they’re calling in and we’re having a productive session even though they can’t physically be here. I find that’s really helpful; it’s much better than simply being on the telephone when someone can’t see you in-person. With video, we can still have a very structured visit, plus I have access to their chart, I can see their expressions, and I can often still see physical findings.

DP: Let’s zoom in a bit. Many tools have been developed to help facilitate Telehealth. In your personal experiences which tools have been most effective in helping to replicate the benefits of being together in the same space?

Dr. MB: I hate to be boring, but the most effective tools are good personal technology! Plus having the right setting. Good lighting, strong WiFi, a clear camera lens, and situating yourself in a space where the doctor can clearly see you.

As I mentioned before, the cellphone is another critical tool in being able to capture physical symptoms before a doctor visit. This can help the session go much more smoothly, and it can even be a tactic a patient might use for in-person visits.

DP: If you could design the perfect Telehealth feature or system to help your patients, what would it be?

Dr. MB: I would design capabilities that would help doctors look at different parts of the body that aren’t possible with telehealth right now.

For instance, I would value an app that simply enables a computer to mirror what a patient’s phone camera can capture. If the patient is pointing their phone somewhere on their body where they can’t see the screen — like the back of their head — it would be helpful for both the patient and the doctor to view what their phone is seeing.

DP: Are there things that you wish patients knew in order to make sure they are getting the best results even though they are not actually in the office?

Dr. MB: Journaling your symptoms is a great way to get ready for a doctor visit. It really helps to be clear about what the symptoms are and what makes them better or worse. Communicating those details help clinicians solve problems. That’s one of the reasons I’m involved in My Journal Health.

Apart from coming in to the appointment ready to describe and display your symptoms and having a clear agenda for what you want to get out of the telehealth visit, something that is important for patients to have after a telehealth appointment is a summary of their visit. This includes critical information on what was discussed during the visit and the plan going forward, so the patient is very clear on what the next steps are and what action they may need to take.

While some EMR (electronic medical record) systems have a portal to make this easy for the patient, it’s something not all doctors have access to. For telehealth, I think it will be important to make sure this feature is available for all doctors and their patients.

DP: The technology is rapidly evolving and new tools like VR, AR, and Mixed Reality are being developed to help bring people together in a shared virtual space. Is there any technology coming down the pipeline that excites you?

Dr. MB: New innovations that I find most interesting are telehealth portals allowing primary doctors to consult with a specialist remotely. I think this is one of the most significant areas of new exploration in medical technology.

How would that work? Some examples include medical stations with an otoscope or an oral light with a camera, which can transmit critical data directly to a computer. Skilled nurse practitioners can examine the patient with these types of tools, gather information on what they see and hear from the patient, and send it to the specialist for a more informed opinion.

Primary doctors might want the input of a specialist who is outside their community. This often requires the patient to travel for a special physical exam. The remote specialty consultation is the next best thing, and I think that’s exciting. As a specialist myself, this is one great way we can provide more patients better access to quality care.

Apart from My Journal Health, another project I’m working on related to this vision is around removing barriers to specialty consultations — specifically looking at ways we can help primary doctors make specialty visits more accessible and efficient for their patients.

DP: Is there a part of this future vision that concerns you? Can you explain?

Dr. MB: One drawback to telehealth is that doctors are missing out on face-to-face interactions with their patients. However, this should not stop technological innovation. I believe we must march forward with proven technology and addressing concerns as we go. In the end, humans are good at trying to figure out how to make things better, and technology is a natural extension of this.

DP: Ok wonderful. We are nearly done. Here is our last “meaty” question. You are a person of great influence. If you could inspire a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger. 🙂

Dr. MB: In the future we will bring the greatest good to the most people by using technology to create a brain trust of reliable medical information. I think doctors can be used as guides and interlocutors for this critical information transfer.

This is important because many patients start by Googling their medical problems, but generally lack the clinical experience to filter out what’s likely and what’s not. This makes it easy for patients to think the worst every time they try to understand medical problems on their own. It’s the doctor’s job to say, “It’s actually this, and you can reliably learn more about it here.”

I think there’s a revolution that will happen by using technology to merge doctors’ clinical experience and expertise into a kind of neural web where input comes in and the best output comes out. This will give patients really good answers and efficient care. It might even involve AI (artificial intelligence), so there would be feedback and learning in the process. Perhaps this will inform a virtual uber-doctor brain that might exist someday.

DP: How can our readers further follow your work online?

Dr. MB: There are a couple ways readers can follow along with me online:

  • Check out my YouTube channel, Ask the ENT Doctor, where I share short videos about all-things ENT, like what happens when your voice gets older or what to do about itchy ears.
  • There’s great content on my medical practice website, Berger Henry ENT Specialty Group, including research and publications on ENT.
  • Take a look at the Resource Center of My Journal Health, which has great tips for health journaling and tracking your symptoms on your mobile device.

DP: Thank you so much for the time you spent doing this interview. This was very inspirational, and we wish you continued success.

This interview was originally posted on Authority Magazine’s Medium account.