Manage Patient Distraction During Telehealth Visits

Sue Boisvert, BSN, MHSA, Senior Patient Safety Risk Manager, The Doctors Company, Part of TDC Group

In order for a healthcare visit to succeed, both the patient and the healthcare practitioner must actively engage. We know that “distracted doctoring” can negatively affect patient safety and inhibit open communication. (For more information about distracted practice, see our article “Distracting Devices in Healthcare: Malpractice Implications.”)

Similar risks can occur when the patient is distracted, a situation that may be more likely to occur during a telehealth visit. Distracted patient behaviors can affect the practitioner’s ability to establish rapport with the patient and collect the information necessary to accurately diagnose and treat the patient’s condition. For example, the patient may not provide a complete history of the reason for the visit, thus limiting the practitioner’s ability to assess signs and symptoms. Distracted patients may miss critical instructions, resulting in nonadherence with the treatment plan, discharge instructions, or follow-up. Patient nonadherence is a known contributor to delayed diagnosis and, consequently, to professional liability claims.

Privacy becomes an additional concern during telehealth visits when the distraction involves individuals in the patient’s immediate environment. Patients may be hesitant to address sensitive health conditions within earshot of others—thus restricting the extent of the clinical discussion.

Strategies to Address Distracted Patients

Consider the following strategies to address and perhaps prevent patient distractions during telehealth visits:

Set technology expectations. Ask patients to shut off nonessential electronic devices (such as televisions, video game stations, and music sources) and to place smartphones on do not disturb or in airplane mode.

Some patients may have difficulty disconnecting from social media, even during a health visit. Behavioral health experts have described this as “fear of missing out” (FoMO), a phenomenon considered to be a symptom of social media or digital addiction. Experts recommend encouraging patients to disconnect periodically to reduce the risk of FoMO.¹ Patients with difficulty disconnecting can be encouraged to use positive self-talk in FoMO situations. For example, instead of thinking “I am unable to answer that call/message/post,” advise the patient to consider “I do not need to answer that now.”²

Set environmental expectations. Advise patients to attend telehealth visits from a private location, preferably at home. (If a patient is attending from a public space, offer to reschedule the visit.) Ask patients to ensure that others in the home are not in the immediate vicinity and, when possible, that children and pets are supervised by someone else during the visit.

Follow up on prior no-show visits if needed. Studies suggest that younger patients and those receiving surgical follow-ups are less likely to present for telehealth visits.³ A 2023 study found, however, that telehealth visits significantly reduced no-show risk for patients residing in socially vulnerable areas or receiving primary or internal medicine care.⁴

Set behavioral expectations. Assess the patient’s behavior at the initiation of the visit and respond accordingly.

Driving: Ask patients who are driving to pull over. For patients who refuse, politely advise them it is unsafe to continue the visit and that they will be rescheduled, then disconnect. If the patient pulls over, discuss your concerns and use your judgment about continuing with the visit.

Smoking: If the patient is smoking, discuss smoking cessation.

Alcohol or substance use: If it appears that the patient is drinking alcohol or using other substances, politely confirm and reschedule the visit. Consider conducting an assessment of the extent of substance use and the appropriate treatment by employing a tool such as Screening, Brief Intervention, and Referral to Treatment (SBIRT).

Physical activity: Ask patients who are walking, using exercise equipment, or performing housework or any other task that involves moving around to find a well-lit space and sit down for the duration of the visit.

Document distracted behavior. Describe the distraction, what the patient was asked, how the patient responded, and the result. For example, “Asked patient to excuse children to another room, she did and visit proceeded.”

The ease and comfort of attending a healthcare visit from home may result in unexpected consequences. Patients may not realize that telehealth visits are held to the same standard of care as an office visit. Practitioners must be prepared to address situations that impede the ability to provide safe and effective patient care via telehealth.

For additional guidance, see our Telehealth Resources or contact the Department of Patient Safety and Risk Management at (800) 421-2368 or by email.

---