Jaspal Singh, MD, MHA, MHS, on How I Practice Now: Deciding Between a Virtual or In-Person Visit and Convincing Patients to Come In

How do you choose between a virtual or in-person appointment for your patients? And how do you convince those that need an in-person visit to come in during a pandemic? In this video, Jaspal Singh, MD, MHA, MHS, explains his decision-making process behind requesting a virtual vs in-person appointment and how he convinces patients that an in-person visit is needed. 

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Jaspal Singh, MD, MHA, MHS, is medical director of both pulmonary oncology and critical care education, as well as a professor, at Atrium Health in Charlotte, North Carolina.


Jaspal Singh: Hi, I’m Jaspal Singh. I’m at Atrium Health. I’m the medical director of both pulmonary oncology as well as critical care education for the Pulmonary and Critical Care Network.

So for the convincing the patient to come in, if they need to be seen, is sometimes a real challenge. Some patients really don’t want to come in, no matter what, and I have several like that that I see. And for them, number one, I need to make sure that I’m communicating with them why it’s important to be seen. It’s not just a matter of just my comfort. It’s a matter of not only do I need to be comfortable, but by the way, while you’re here, we’re also going to do this or we’re going to do this. Or you know what, you and I need to talk about some serious issues, and I want to be able to understand how you’re processing it, making sure that my staff is here to help you because these issues are challenging. Or you may need pulmonary function testing, or you may need additional sort of ambulatory saturations or other assessments that, at the same time, we can coordinate and then make a decision based on the aggregate of information, not just simply conversation. That is beyond just a conversation.

Now, for those are just a conversation actually or a follow-up of a diagnostic test of some sort, then a virtual visit or just to check in for a patient on CPAP therapy, for example, how they’re doing, the virtual visit works great. Generally, I can have a lot of metrics, I can have a lot of things. If there’s not a lot of anticipated wavering of the standards, or I don’t anticipate a major change in plan of care, or they’re on a maintenance program, or just made some minor tweaks to their health care, then I think virtual visit works really well. 

So when there’s major changes or major coordination required or additional diagnostic testing that may pivot the decision making, then an in-person visit is often helpful. If I’m going to do an ultrasound at the bedside, I oftentimes tell them, you know, what I really can’t tell until I do an ultrasound of what’s happening, or listen to your lungs more clearly, or look at your airway examination, and oh, by the way, while you’re here, I also want you to see so and so. And so we’re trying to coordinate all that; it has to be more than just a conversation. 

If it’s just a conversation, virtual is great. If it’s just a follow up with some basic parameters, virtual is great. But if it’s more than that, then I might consider an in-person visit. And I might have to convince them that it’s safe. So to do that, we got to make sure the patient has no symptoms, that they do a symptom screen, that we make sure that they’re not sick, that they know the visitation rules for families as well. And those are all factors. 

Now for a complex patient who I need to bring a family in and more than just 1 member, I may do both—both the virtual as well as in-person. Or sequence them one after the other to make sure that the family members are included in the decision making involved.