In the February article from “The 12th at 12 PM” series, Małgorzata Wywrot
from the Polish Chamber of Physicians and Dentists (Naczelna Izba Lekarska)
shows that in teleconsultations it is not technology, but communication that
determines patient safety. A wellconducted conversation becomes a key
clinical tool – from the very first minutes of contact to a clear and structured
summary of the recommendations.
A teleconsultation as a form of providing healthcare services is not a simplified
version of an inoffice visit. It is a distinct mode of care delivery in which part of the
information – especially nonverbal cues – is limited, and physical examination may
be impossible. As a result, the conversation becomes the primary clinical instrument:
it should be structured, conclude with a clear summary of the recommendations,
include checking patient understanding, and be followed by reliable documentation.
In this sense, a teleconsultation is a process, not a onetime exchange of words
(Telemedyczna Grupa Robocza, 2021/2022).
The topic of communication as a clinical competency in ehealth is discussed
more broadly in an interview with Małgorzata Wywrot titled “EHealth
Communication as a Key Clinical Advantage”
Safety Begins in the First Minutes of the Conversation
The first minutes of a teleconsultation should create safe conditions: confirming the
patient’s identity and ensuring that confidentiality requirements are met on both sides.
This is a required element of the care standard, not merely a “polite introduction.” The
organizational standard for teleconsultations in primary care mandates identity
verification, confidentiality, and documenting the teleconsultation (Ministerstwo
Zdrowia, 2022). In this respect, communication in teleconsultations acts as a safety
mechanism – clinical, organizational, and legal at once.
For the same reasons, choosing the appropriate tool and channel of communication
is essential. The communication channel affects information security, comfort of the
conversation, and the extent to which the entire process can be justified clinically,
organizationally, and legally – particularly regarding data protection and
accountability (Telemedyczna Grupa Robocza, 2021/2022). In practice, this means
using solutions designed for healthcare services rather than adhoc tools.
A smooth transition from the “framework” to the substance of the conversation is also
important from the patient’s perspective: clear rules foster clarity, reduce tension, and
limit the risk of misunderstandings.
A Teleconsultation Is a Care Pathway, Not a Single Call
Teleconsultations work best when designed as a pathway, not a single connection.
Before the conversation, it is crucial to prepare the patient and set clear rules of
contact. The patient should know what the service will look like, what information to
prepare, and in which situations teleconsultation is not appropriate and an inperson
visit will be required (Ministerstwo Zdrowia, 2022). This stage often determines
quality: less time is spent “figuring things out on the fly” and more on clinical
decisionmaking.
During the teleconsultation, structure is key. When the clinician cannot see the
patient – or sees them only partially – the importance of organizing the history,
closing discussion threads, and actively checking comprehension increases. Simple
techniques help in practice: paraphrasing, brief summaries after key parts of the
conversation, and finally asking the patient to “repeat the recommendations in their
own words.” This does not significantly extend the visit, but it clearly reduces the risk
of divergent interpretations.
After the consultation, the most important element is closure: clear recommendations,
a plan for next steps (what happens next and when), redflag symptoms (“when to
seek immediate help”), documentation in electronic medical records, and ensuring
the patient has access to the information arising from the consultation (Ministerstwo
Zdrowia, 2022). This stage is where misunderstandings most often arise, which is
why closure should be treated as a safety standard rather than an optional addon.
Accessibility Requires Clear Rules, Not Constant Availability
Teleconsultation is sometimes mistaken for “constant availability.” In reality, system
stability comes from predictable accessibility: the patient knows how to reach help,
and the medical team works under conditions that allow them to maintain quality and
safety.
Crucial here is directing the patient to the appropriate form of contact (triage): who
should receive a teleconsultation, who a video consultation, who an inperson visit,
and within what timeframe. Triage can be performed by staff or supported by digital
tools; what matters is that the criteria are transparent and integrated into the care
process (Telemedyczna Grupa Robocza, 2021/2022). From a clinical safety
perspective, it shortens the path to the right type of assistance, especially in urgent
cases.
Thus, triage is not only an organizational tool but also a form of system-level
communication that directly influences patient safety.
Conversation Protocols: Structured Dialogue Reduces Error Risk
In teleconsultations, conversation is both a diagnostic and therapeutic tool, so it is
worth standardizing it where possible. Conversation protocols and frameworks are
not meant to “rigidify” the interaction but to bring order to moments where chaos
easily arises: nonspecific symptoms, multiple simultaneous concerns, emotionally
difficult conversations, or situations requiring clear instruction.
An example of an approach to telephone and video consultations is the CONNECT
protocol, designed to facilitate the delivery of difficult information in a structured
manner (Sobczak et al., 2022). From a qualityofcare perspective, it is equally
important that communication competencies are developed systemically, as part of
education and professional development, not only “picked up along the way.” In
telemedicine, this need is particularly pronounced: fewer nonverbal cues mean
greater responsibility for the precision of spoken language.
Communication Competencies Require Systemic Support
There is a growing range of training opportunities that build practical communication
skills with patients, including in the context of remote services. Notable examples
include:
- training on communication that supports patient collaboration,
- professional courses on communication in healthcare, including nonverbal
communication and practical exercises, - training that clarifies telemedicine, law, and responsibility, helping to reinforce
the safety aspects of tools and data.
In telemedicine, communication is not a “soft skill” – it is a clinical safety component
that requires the same systemic approach as procedures, tools, and documentation.
Regardless of the form of care – whether in person, by phone, or online – preparation
of both the physician and the patient is the foundation of safety and effective care.
Clear conversation rules and awareness of the consultation structure support sound
clinical decisions and reduce the risk of misunderstandings. The most effective
approach to developing communication competencies is inperson training, in
simulation environments, or during live practical sessions, which allow participants to
practice observing nonverbal signals and responding in difficult situations – skills that
can later be effectively applied in telemedicine practice.
Małgorzata Wywrot – Manager of Health Innovation Programs and leader of NIL IN
– The Network of Innovative Physicians at the Polish Chamber of Physicians and
Dentists. She leads programs and initiatives supporting practical implementation of
innovation in healthcare. She specializes in communication in medicine and practical
training that supports physicians and clinical teams in everyday practice. Lecturer at
the Postgraduate Medical Education Center in the Lifestyle Medicine Department of
the School of Public Health.
References:
Ministerstwo Zdrowia. (2022). Standard organizacyjny teleporady w podstawowej
opiece zdrowotnej (Dz.U. 2022 poz. 1194);
https://isap.sejm.gov.pl/isap.nsf/DocDetails.xsp?id=WDU20220001194
Sobczak, K., et al. (2022). The “CONNECT” Protocol: Delivering bad news by phone
or video call. International Journal of General Medicine, 15, 3567–3572;
https://doi.org/10.2147/IJGM.S358723
Telemedyczna Grupa Robocza. (2021). Interdyscyplinarny standard udzielania
świadczeń telemedycznych (Version 2); https://telemedycyna-
standard.pl/api/file/events/rtgr/TGR_Interdyscyplinarny_standard_udzielania_swiadcz
en_telemedycznych-v2.pdf