Practical Strategies for Building Patient Rapport Via Telehealth

Even when meeting virtually, there are several ways clinicians can foster strong therapeutic relationships with their patients. In this video, filmed at Psych Congress 2023, Steering Committee Member Edward Kaftarian, MD, discusses effective strategies for building patient rapport via telehealth. From displaying attentiveness via nonverbal cues to setting a professional tone with an appropriate background, Dr Kaftarian offers practical methods for clinicians to establish trusting, effective therapeutic connections in virtual settings. 

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Read the Transcript

Edward Kaftarian, MD: Hello, my name is Dr Edward Kaftarian. I'm a board-certified psychiatrist and executive chairman of Orbit Health Telepsychiatry. I'm also on the Steering Committee for Psych Congress.

Psych Congress Network: Can you share any specific tips or strategies for building rapport and trust with patients in a virtual environment, where non-verbal cues may be limited compared to in-person interactions?

Kaftarian: It’s really important to establish rapport with patients, whether you're in person or via telehealth. With telehealth, the challenge is that the nonverbal cues can actually be amplified. Most people assume that you don't notice the nonverbal cues, but I would say that you notice them even more with telehealth.

For example, if the provider has a grimace on their face, they just look unfriendly, or there's something else about them that's not optimal in terms of the interpersonal interaction, that actually can be enhanced because the patient will often be particularly focused on the appearance of the doctor. Whereas if you're in the doctor's office, there are other things that distract you from a pure focus on the doctor's appearance. It’s really important that you appear professional. I think that it's good to dress up for the occasion as much as possible. I think it's important to maintain good eye contact and the eye contact should be done in the camera. Oftentimes when we're looking down and typing, we're not looking at the camera lens and the patient may feel that we are not really listening to them even though we might be, and this is the case in person as well—I think we've all had experiences where people were looking down at their phones or their computers and you don't feel like you're being heard. So, you have to make a particular effort, whether you're in person or via telehealth, to make sure to maintain eye contact. 

Also, you want to be sure that your office conveys a professional setting, so whatever the patient is seeing, their view of your frame, everything there needs to appear professional. You don't want to have too much of a personal background, though. You can have some things that convey that you're human and that you're a real person—and in fact, real backgrounds are better than fake backgrounds because it does give a sense that you're really there with the patient—but you want to be careful about what you reveal in your background and how professional that is. 

I would say that it's not only your appearance on camera, but it's also your background, and then also you want to be sure that you're not making additional noises that affect the rapport. For example, if you're rustling papers near the speaker, that affects the patient's ability to connect with you because they're hearing the sounds of the paper, and oftentimes, microphones pick up on that more than even your own voice. You want to make sure that your speaker is not positioned in a way where it's picking up sounds that you don't want the patient to hear.

All of these things build rapport. 

Another thing that I would say that helps is to explain what the patient should expect before the session. I think with medical care, patients always like to be given a heads up on what to expect. It’s sort of like if you're a pilot of a plane and you're about to hit turbulence, you want to make sure that the passengers on the plane are aware of that turbulence. With telehealth, hopefully you won't have a lot of turbulence, but it's helpful to start the session by saying, "Listen, if we have any glitches or if you're not hearing me clearly, please let me know and we'll fix it. These things often occur with telehealth, but it's very fixable.” Give the patient the sense that, even if something goes wrong, things can be corrected. If that effort is made, I think that the patient will develop a better rapport with you.

Edward Kaftarian, MD, is a preeminent authority in the field of Telepsychiatry. He holds a distinguished seat on the Telepsychiatry Committee of the American Psychiatric Association and is a member of the Steering Committee for Psych Congress, the United States' largest independent mental health educational conference. Additionally, Dr Kaftarian is a prominent speaker on the rules and regulations governing telehealth. Dr Kaftarian completed his psychiatry training at the prestigious Johns Hopkins University and holds board certifications in Psychiatry, Forensic Psychiatry, and Addiction Medicine.

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