Listen carefully because you have to judge their emotions and their concerns not just from their words but from the tone and cadence of their responses
Telehealth Best Practices: Dr. Rohit Varma of CHA Hollywood Presbyterian Medical Center On How To Best Care For Your Patients When They Are Not Physically In Front Of You
Rohit Varma , MD, MPH, is the chief medical officer of CHA Hollywood Presbyterian Medical Center , a nationally recognized acute care facility providing compassionate care for Hollywood and its surrounding communities since 1924. He is also the founding director of Southern California Eye Institute (SCEI) located within CHA HPMC. An accomplished physician-scientist and board-certified ophthalmologist, Dr. Varma is renowned as an expert in glaucoma and the epidemiology of eye diseases. He is also studying new imaging techniques in the early diagnosis of glaucomatous optic nerve damage. Dr. Varma has authored or co-authored more than 275 articles in peer-reviewed journals and edited or authored three books. He has also served as principal investigator for studies on blindness and vision impairment for the World Health Organization and is one of the highest National Institutes of Health-funded vision investigators, with continuous funding for more than two decades, demonstrating the importance, relevance and impact of his work.
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 interviewing Rohit Varma.
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?
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 been practicing for around three decades. My dad was a physician and my uncles, aunts, and cousins are also physicians. Growing up, I saw them make a huge difference in the lives of people and it influenced my decision to enter the field of medicine and public health and become a physician. My main goal is to make people’s lives better — bring hope and a little light into their lives. I try to help them see better, so that they can function better. The most important goal is that vision loss should not become a burden on them or their families — this guides me in everything I do. I am truly grateful and feel humbled by the fact that I can help people, especially those who were not able to see before. It is such a privilege to help patients save their vision or better yet, get their vision back and see better.
Can you share the most interesting story that happened to you since you began your career?
I am humbled and privileged to have worked with Mother Teresa in India, Albania, and in the US. This opportunity allowed me to work with orphan babies, malnourished children, patients with leprosy and with the dying and the destitute. She set such high standards and was the best role model. If there are three words that epitomize her they are: humility, simplicity, and faith. Even though she had accomplished so much in her life, she was always humble — the first to get up in the morning and the last to go to bed after making sure everyone was taken care of. Working with Mother Teresa changed my life and served as a guidepost for me to devote my life to helping vulnerable communities with my work. I began to explore working in public health and since then my work in public health has been some of the most rewarding and gratifying work in my career. More recently, it has helped me to work with our leadership team at CHA HPMC to guide our medical center navigate the coronavirus pandemic.
Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?
My father always told me: “Never be deterred from achieving your goal”. There are many paths to achieving any goal, so if one approach fails try a different approach and if that fails try another approach until you are able to achieve your goal. I became a physician in India and obtained my advanced training in ophthalmology at Johns Hopkins Hospital and my public health training at Johns Hopkins University. There were many occasions in my career, when I needed to modify my approach to achieve my goal. But I am very grateful to my father for having instilled that “can do” ethic, because it has been very instrumental in helping me work with vulnerable communities to reduce the burden of illness.
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?
I have had so many amazing mentors in my life and am so grateful to each and every one of them. But the two who stand out are Mother Teresa and my father, as expressed in previous questions.
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?
The single most important benefit of having a patient in front of you is the connection and trust you build from being there for them — being there to listen to them, being there to examine them, and being there to understand their emotions, worries and concerns. The proximity and focus in the patient is critical to building a healthy physician-patient relationship — communicating not just by words but also by your body language that you are there for them and you will serve as their advocate on this journey of healing with them.
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?
I think it is not always possible to get a sense of the emotional state and concerns of the patient, if they are not in front of you in person. Again, this is very important in building a strong connection with the patient and giving them the sense that you are in this journey with them and together you will help navigate them through their illness.
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.)
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?
The biggest advantage of telehealth is that it allows easy and ready access to the physician. This allows one to address concerns that don’t need a clinic visit. For those who are in remote areas, telehealth provides an opportunity to get advice from some of the best physicians and experts in the world which may otherwise not be possible. Through telehealth, I’ve examined many patients who developed blurred vision and were worried, but they did not want to come in for a visit. Once I had a telehealth visit with them, it was determined that they had dry eyes and their vision could be improved by using artificial tears. I had another patient whose eyes were itching after starting a new eye drop. The patient was willing to tolerate the itching until their next visit, which was six weeks later. After a telehealth visit the next day, it was determined that the patient was having an allergic reaction to the drops and the symptoms were resolved after stopping the current drops and starting a different one.
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?
The creation of apps that allow me to do a more detailed examination of the patient has been very helpful. FaceTime is also a very helpful tool. While these are helpful, they do not replace the benefits of in-person visits — especially for my specialty of ophthalmology.
If you could design the perfect Telehealth feature or system to help your patients, what would it be?
It would be beneficial to have a telehealth system with the capability to look into the eye and examine its inner structures, and perform some functional testing to see if they are functioning normally or are diseased.
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?
Patients can always call and request a telehealth visit with an opportunity to see their physician and have the physician examine them and respond to their concerns. They should not feel shy to ask for a telehealth visit anytime they feel the need.
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?
These are very exciting technologies that can bring value to the patients. VR can help improve communication between patients and physicians, and help improve their understanding of their disease and get a better understanding of surgical treatments. It can also help train medical students and physicians, and help physicians learn newer techniques in a safer manner.
Is there a part of this future vision that concerns you? Can you explain?
I worry about the possibility that such technologies may lead to a lack of personal touch that is integral to the patient-physician relationship. In the end, we need the personal human interaction to heal. I worry that such surrogates for true, personal interaction may diminish the interaction between patients and physicians, and thus lead to a less trusting and meaningful bond.
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. :-)
I would create a National Health Service corps that creates a pathway for high school students, college students, medical students, nursing students, social work students, pharmacy students, and others to help improve the health of our vulnerable communities — both in the US and around the world.
How can our readers further follow your work online?
Readers can follow me and my work on www.sceyes.org.
Thank you so much for the time you spent doing this interview. This was very inspirational, and we wish you continued success.