I provided genetic counseling in a traditional clinical setting for more than ten years prior to joining PWNHealth. Patients would arrive at the clinic, check-in at the reception desk, hear their name called from the waiting room, and then be guided into a small conference room to await their appointment with me. I would walk in, donning my official-looking white coat, and introduce myself.
What transpired over the next few minutes was routine, medical small talk. I confirmed the person before me was indeed the patient I was expecting, verified by which provider they had been referred, and asked them to substantiate the indication for their visit. Sometimes, those early exchanges also included comments on the weather, local road construction, or how a sports team was faring that season. This chit-chat provided a platform not only for me to collect necessary information for the patient’s chart, but also to start to assess the sea of non-verbal information before me.
From the time I walked into the room until our consult was complete, I was constantly observing. I would notice the nervous tick of a vibrating leg below the table, reddened eyes due to tears shed earlier that morning, or a notebook and pen positioned to record my every word. I could see who, if anyone, came with the patient for support. Clothing sometimes gave me a hint as to how the patient typically spent their day. Whether children were present, and how many were there, gave me a glimpse into their family and, potentially, a source of their concern. Mannerisms — the narrowing of eyes, the crossing of arms, a glance made toward their partner — were all subtle signs to help me better understand the person before me. I synthesized this information, often unconsciously, and intertwined it with what was spoken. Doing so allowed me to decipher the best way to guide the patient in their decision making and adaptation to their condition and/or testing result.
Reciprocally, the patient would gather similar information from me. They could see the warmth of my smile, the way I leaned toward them, ever so slightly, in a gesture of engagement, and the subtle nod of my head simultaneously expressing “I hear you” and “keep talking.” The patient and I communicated both with and without words and in doing so, forged a connection.
Now, imagine my walking into that same clinic setting, except both the patient and I are blindfolded. We can hear each other, but have lost all visual cues. How would the appointment change? Can we still connect in the same way? This is the challenge of telehealth.
At PWNHealth, all of our appointments are conducted through telehealth. At least three-quarters of our genetic consults are done via phone, while the remainder are through our video platform. Providing genetic counseling on the phone is akin to being blindfolded in the clinic.
How, then, does the PWNHealth genetics team excel at providing genetic counseling while being “blindfolded?” To start, we recognize and embrace the uniqueness of telehealth. We know this is an alternative service delivery model that offers great convenience to the patient and we step up to the challenges it can present. While other providers may have abruptly begun providing telehealth services due to the national pandemic, this is mainstream for us.
Our team of full-time genetic counselors has over 60 years of combined experience. Instinctively, we draw upon that to employ the same general tactics we have always used in the clinical setting, adapting them to phone and video. While on the phone, the patient can’t see the nod of my head as I listen to them talk, so I interject with more validating statements to express that I am actively listening. Similarly, when the patient discloses the death of their sibling, they can’t see the way my facial expression falls at this news, but my empathetic tone enables them to know I hear the impact of their loss.
I pay attention to the cadence with which the patient speaks, how and where they pause their words. It’s not just what is said, but how it is expressed. I notice their vocabulary and whether it’s accentuated with an accent. All of these pieces of information help me better understand the patient, as a whole. While I can’t razz them about a sports logo on their shirt, we can find common ground discussing their barking dog in the background or the difference in the weather between our regions of the country.
Our telehealth service provides patients access to necessary and impactful healthcare. We can reach individuals all across the country, including those in remote areas whose internet bandwidth may not support a video consult. Offering genetic counseling while “blindfolded” provides a medium that fosters engaged listening and strong communication. At PWN, I aim to build a connection with patients such that, despite us not being able to visualize one another, the patient hangs up the phone confident that they have been “seen.”
Authored by Heather Glessner, MS, CGC, Clinical Genetic Counselor at PWNHealth
For more information about PWNHealth visit pwnhealth.com
