Respect that as frustrated as you get, it can be equally frustrating on the other end. When technology challenges arise, it is easy to get frustrated with the situation. Many times I have felt that if an encounter wasn’t going well I just wanted to leave and do it another time. I remember one such time when both the patient and I had to continually repeat ourselves because the audio kept cutting out. I almost requested to reschedule, but I thought to myself “would I walk away from my patient if they spoke another language”? No. I’d go get a translator. So we finished the remainder of the call on the phone. I could hear the relief in his voice that we could talk clearly again.
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, I had the pleasure of interviewingDr. David Violette.
Dr. David Violette is an experienced Senior Vohra Wound Physician and currently serves as a Fellowship Program Director at Vohra Wound Physicians. He has a demonstrated history of working in the hospital and health care industry as well as the post-acute & long-term setting. Dr. Violette earned his M.D. from Virginia Commonwealth University School of Medicine before completing a residency in General Surgery and Fellowship in Critical Care at Boston University Medical Center. He is board certified in General Surgery, Surgical Critical Care and is a Certified Wound Specialist Physician (CWSP). He is skilled in Healthcare Management.
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?
I’ve always been told that I was destined to be a physician. When I was around age 5, my parents snapped a photo of me with a toy stethoscope. From an early age, they seemed to know where my life was heading, even if I didn’t. I caught up at some point early in my college years when I realized that helping people was all I wanted to do with my life. Medical school and a residency in General Surgery soon followed.
At the start of my career, I was practicing general and trauma surgery. But I soon realized that although I loved the field, I had another calling. As part of my practice, I also worked for a wound care center in the hospital. I really enjoyed helping patients with challenging wounds, ones that other physicians couldn’t seem to heal. It was very satisfying to see them get back to their regular lives again. After several years of that practice, I had started a family of my own. I began to realize that there wasn’t enough “work-life” balance to give the time to be a dedicated healer, father, husband, and to take care of myself. I knew it was time for a change from the hospital system. Because of my love for outpatient wound care I sought employment with Vohra Wound Physicians, the nation’s largest wound care company working in both long-term care and nursing homes. Working with the elderly in these facilities has allowed me to take my skills to them, rather than the other way around. This in turn is easier on them, especially in the face of chronic illnesses like arthritis and dementia. Over the years, I’ve also been fortunate to become a member of senior leadership with the company, a role that is very satisfying as I am able to help impact the direction of the company.
Can you share the most interesting story that happened to you since you began your career?
The most interesting story dates back to when I was working as a trauma surgeon. A big storm had recently come into town and knocked down many trees and tree limbs. A trauma alert came in one evening for a man who had fallen 30 feet and had multiple injuries. He had needed to saw down the end of a branch from a tree in his yard. So, he tied a rope around his chainsaw and climbed up 30 feet into the tree. Standing on a sturdy limb he proceeded to saw the limb. Unfortunately, instead of sawing the end side, he sawed the side he was standing on and fell. He quickly earned the nickname “Wiley Coyote” after the famous Roadrunner cartoons!
Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?
“At the end of the day, when you lay your head on the pillow, can you say that you did the best you could do?”
One thing that I learned early in medicine was that there is no substitute for giving your all. At the beginning of medical school, I learned a very valuable lesson in treatment. In about my third year, there was a list of tasks that I was supposed to perform after a Friday night on call. One of these included drawing patients’ blood. On the last patient with the last syringe, I accidently dropped it onto the bed, but quickly picked it up and used it instead of getting a new one. That weekend I was terrified that I had caused him harm. On Monday morning, I realized he was fine, but it taught me a valuable lesson. Never give less than your all. If there is something nagging you, follow up on it. If there is a test pending, see it through before leaving. There will be bad things that happen to your patients, but never let it be because of your failure to give 100 percent. I can honestly say that after that incident, I’ve never had to relive that experience.
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?
Throughout my life, I’ve had many people help me. So many in fact that it is tough to even single one out. One person that made a huge difference to me in my life was a high school vice principal. There was a time that I had done something dishonest. He knew what I had done but asked me honestly anyway. Like many children, I tried to lie my way out of it. After repeatedly asking me if that was indeed the truth, he wrote me a pass to go back to class. I had one foot out the door before I ripped it up, stepped back into his office and told the real truth. He smiled and told me that “The truth will always set you free”. He told me that day, and many more to follow, that I had a good heart, and needed to listen to it. There are many days that I close my eyes and can still hear his voice.
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?
For nearly every facet of medical training to this point, our interactions with patients have been face to face. Firstly, there are obvious medical advantages to being able to touch and feel a patient’s skin. These are the foundations of our medical training. But there is a certain connection that humans feel when they are face to face. I can look into my patient’s eyes and see joy or sadness. I can feel their energy in the room when they are uneasy or scared. Lastly, I can hold their hand and comfort them when they need empathy.
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?
First and foremost, one of the greatest challenges includes technology. It is difficult enough to treat patients the best way possible when they are in front of you, but when images are blurry, or audio skips, key words may be lost without either party knowing. It also can be frustrating to both patient and provider to have to continually repeat themselves, which can be disruptive to the thought process. I think we can all relate to “glitchy” media platforms in the era of this pandemic. This is why having an appropriately lower bandwidth communication platform such as the Vohra Integrated Video Platform can be so beneficial. It is far better to have clear communication and appropriate video, than strive for crystal clear HD 4K and have constant interruptions.
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? (Please share a story or example for each.)
- Respect that as frustrated as you get, it can be equally frustrating on the other end. When technology challenges arise, it is easy to get frustrated with the situation. Many times I have felt that if an encounter wasn’t going well I just wanted to leave and do it another time. I remember one such time when both the patient and I had to continually repeat ourselves because the audio kept cutting out. I almost requested to reschedule, but I thought to myself “would I walk away from my patient if they spoke another language”? No. I’d go get a translator. So we finished the remainder of the call on the phone. I could hear the relief in his voice that we could talk clearly again.
- Tell your patients that you will do your best job to take care of their needs. It is so easy to get dehumanized by technology. In the patient-physician bond, there is a great deal of trust. I have found it important to verbalize to my patients that although this may not be either of our preferences, nor even remotely ideal, that I would do my best to help them as best I could. I have always believed that patients value honesty and caring, as much as the medical assessment and treatment, from their providers. It is important to reassure them of that.
- Smile. (with teeth). Along the lines of technological depersonalization, many times it is easy to fall into the trap of appearing like an automaton while conducting a visit. One of the ways I have been able to connect with my patients is to remember that this encounter should look and feel the same as if I were there in person. Sometimes it is even appropriate to tell a joke, laugh or smile. Don’t let the screen make you more sterile.
- Be flexible. There are going to be times where nothing seems to be working well. It is easy to force an encounter with a patient even though both parties are getting frustrated. I recall a telemedicine visit with a woman and a complaint of a “bump” on her abdomen. It wasn’t there on the call, and she couldn’t show me where it was or describe it. There was no way for me to feel her abdomen to know what was going on. I asked her if she wanted to reschedule, and she did. On our next visit, the hernia was present. She was happy that I could see it, and I was confident in my diagnosis.
- Don’t be afraid to ask for help (on both ends). People don’t ask for help for a variety of reasons. Sometimes they simply don’t know that they are struggling. Other times, they feel that they can work it out themselves. Sometimes there is fear that others might think less of them for not knowing something that they think might be simple. The fact of the matter is that there is a reason that IT departments exist. Don’t hesitate to contact them. Feel free to ask a colleague if there is a different or better way to approach a technological challenge. Remember that patients have the same problems. This is particularly true for our elderly. Ask if there is a family member that might be able to assist.
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?
Although telehealth can present many challenges, it also offers many ways to improve care as well. One example is that in my wound care practice, I typically see patients once a week. Unfortunately, sometimes they need more than that. A nurse might be concerned that the patient has developed an infection in between visits. Prior to my utilization of telehealth, such inquiries might have been handled on the phone. Today, I am able to connect virtually with both my nurse and patient in real time to see the problem and ask questions. This has led me to me to be much more confident in my diagnoses. In addition, new patients no longer need to wait until the day that I am at the facility. I am able to use telehealth on the day of their admission to provide as prompt of care as possible.
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?
As I mentioned earlier, one of the most important aspects of a good telehealth encounter is an appropriate platform and appropriate bandwidth. Another key to maintaining a good encounter is your level of professionalism. Utilizing an appropriate background for yourself helps the patient on the other end feel as though they are in an office setting. I try to ensure a quiet setting, and I always make sure to dress professionally with a white lab coat as well.
If you could design the perfect Telehealth feature or system to help your patients, what would it be?
In a perfect world, I would have multiple screens to view at the same time. I’d love nothing more than to be able to examine a patient while also being able to see their facial expression as I talk to them. If there was a way that I could control the camera screen remotely from my terminal, it would greatly increase my efficiency and also decrease the burden on the other end. This way, I continue to have a global view of the room while also maintain control of the view of the patient’s health concern. In other words, a picture-in-picture view would be the ideal situation.
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?
The advice I would give to patients would be to come prepared just as you would to a live encounter. Bring a list of questions if that is your normal habit. Be prepared for technological challenges. Make sure your WiFi access is up and running.
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?
The world of extended reality is absolutely fascinating with regards to virtual health environments, particularly in wound care. As a general surgeon, one of the challenges first faced in earnest in the 1990’s was the rapid expansion of laparoscopy. Surgeons needed to translate their former 3-D tactile experience into a 2D screen. Fast forward 30 years to this time when current technology, like virtual reality, is bringing depth perception back into the equation. I can envision a world where not only can I see the wound but virtually measure its depth. Camera matrix grids already approximate wound surface area. Imagine if we could also accurately assess volume virtually.
Is there a part of this future vision that concerns you? Can you explain?
Absolutely. Technological advancements are a wonderful augmentation to the physician-patient interaction in the virtual telehealth space. We need to make sure that we don’t rely on them exclusively and continue to foster our interactions between each other though. There will never be a virtual replacement for a friendly smile and a handshake.
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. 🙂
As we evolve as a society — in medicine, technology and humanity — I dream of a world where access to healthcare is never a struggle. It is available via a variety of platforms, both remote and in person. Patients can easily and efficiently navigate to the services they need when they need them without worry.
How can our readers further follow your work online?
For further information on Vohra Wound Physicians and the Patient Telemedicine Program please visit VohraWoundCare.com or contact the Vohra@Home hotline at 954–613–0391. Links to social media platforms are found below:
Thank you so much for the time you spent doing this interview. This was very inspirational, and we wish you continued success.