Dmitry Ruzanov: doctor-patient communication via telemedicine can and should be effective!

Interview with the Head of the Republican Scientific and Practical Center for Medical Technologies, Informatization, Management and Economics of Healthcare in Belarus.

In May this year, Russian Research Institute of Health (RIH) became one of the organizers of the first free educational course on the topic of healthcare digitalization in the CIS.

The course was called "Digital Healthcare" and covered the latest technologies of digital healthcare: the nuances of digital document management, patient data protection, the latest digital tools and services, and introduction of telemedicine consultations. The course speakers were experts in the field of digital health from the Commonwealth countries.

Dmitry Ruzanov, PhD in Medicine, Associate Professor, Head of the Belarusian Republican Scientific and Practical Center for Medical Technologies, Informatization, Management and Economics of Healthcare, told about telemedicine and the peculiarities of professional communication in remote consultations process.

- Dmitry Yurievich, judging by the age of your publications, you are a pioneer of telemedicine. Please tell us about your experience in organizing telemedicine consultations.

- Yes, indeed, the first telemedicine consultation took place more than two decades ago, when in 2002 the Gomel Medical Institute received modern innovative at that time computer and network equipment within the framework of the international WHO project "Medical care for children affected by the Chernobyl NPS catastrophe through the development and implementation of telemedicine" with the support of the Sasakawa Memorial Medical Foundation (Nagasaki, Japan). First of all, the most demanded were consultations in remote areas affected by the Chernobyl accident and experiencing staff shortage at that time.

- How did the idea of creating the "Digital Health" course appeared?

- The idea to develop the course was discussed back in 2022 - we agreed that it would be good to implement joint educational programs within the CIS, where representatives of the CIS countries would share their experience. By discussing our experiences, we can understand which practices are really good and which are not so effective, and negative experiences can avoid other countries from making mistakes.

When thinking about such a course, we understood that we should raise the most topical issues - for example, informatization, which involves all CIS countries. However, the countries differ in their regulatory aspects, approaches to informatization, and level of equipment. Telemedicine is probably the most popular topic in digitalization.

- In the beginning, telemedicine was viewed with skepticism.

- Yes, it was believed that telemedicine consultation is a low-impact endeavor and will never replace live communication. Therefore, it is important to know the nuances that can compensate for the lack of live communication. During the course I told how to set up the screen, what speech turns make communication more lively, what are the possibilities of non-verbal interaction, demonstration of visual illustrations and videos.

- What verbal techniques should be used during a telemedicine consultation?

- "Straightening reflex" of the doctor does not work well during a "live" consultation, and in a telemedicine consultation it is useless at all. First of all, you should avoid mentoring in communication with the patient: "you should". This generates internal subconscious resistance - "I don't owe anyone or anything". There is no need to be directive, no need to frighten with consequences, using alternative formulations such as: "If you don't take it, then you will have a stroke". The patient is already anxious when going to a doctor, and such words from healthcare professional can lead to even more anxiety, resistance, additional psychosomatic disorders. Of course, the patient's satisfaction with such consultation will be low.

It is better to give the right to choose, as no one likes to be forced. The patient's dualism in making decisions leads them to a false conclusion: "I will not buy and take medicines if I am "forced", and there will be no side effects, so why I should waste money". It is better to show the advantages of following recommendations: "If you take these medicines, you will live a long happy life without complications". The meaning is the same, you convince the patient to adhere to the treatment course, but there is no mentor tone, and the responsibility is shared with the patient, and not only took it upon yourself.

- Are there any non-verbal techniques that are important in telemedicine?

- You can and should definitely use gestures, so you should be able to see your hands in the frame. It is fundamental to smile. Touch can be imitated by asking the patient to count his own pulse or measure his blood pressure, you can point out mistakes in tonometer use, most patients make them. It is important to look at the camera, not the screen. If you are looking at the screen, the patient will think you are looking down.

- In your opinion, do you think there should be more events like the "Digital Health" course?

- Yes, because this is a great opportunity to learn from each other, and we can see that the audience was interested in the format. It is only necessary to select topics that are relevant to everyone, and if we talk about the example of a country and mention legislation, we should use references to normative documents so that listeners can familiarize themselves with them and delve deeper into the topic.

To remind: the course "Digital Health" was held from 15 to 19 May this year, and on May 23 a round table for the program participants was held. The organizers of the course were RIH, the Republican Scientific and Practical Center for Medical Technologies of the Ministry of Health of Belarus and the National Scientific Center for Health Development named after S. Kairbekova of the Ministry of Health of Kazakhstan.

1,317 people from Armenia, Russia, Azerbaijan, Belarus, Kazakhstan, Kyrgyzstan and Turkmenistan registered for the course.