Choose a zen place to do your televisit. “Telehealth manners” are important and valuable, looking at the camera and not just the video display of the patient, is key to interacting effectively with a patient over a screen and making them feel safe and comfortable.
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 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?
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 Ivel De Freitas.
Dr. De Freitas is an internationally recognized longevity expert and personalized biomolecular medicine doctor. She has over 20 years of professional experience as a medical doctor. Graduated top of her class, with a unique professional background that combines research and clinical practice of traditional, alternative, and innovative medicine, Dr. De Freitas has become a pioneer in innovative and regenerative medicine. Her positive energy, empathy, love, and forward-thinking passion for medicine and technology drove her to create a company dedicated to bringing medicine to the next level using Telehealth and artificial intelligence to empower patients to “biohack” their health to become the healthiest, happiest, and absolute best version of themselves.
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 am originally from Venezuela. I am the first doctor in my family. But I think I started practicing medicine even before I realized I wanted to be a doctor, while I was in High School. I was passionate about wellness. I was continuously biohacking my own health and diet, always trying new things to enhance them, kind of using my own body as my personal lab. I was on a vegan diet, when vegan was not a thing, I was drinking green juices when nobody knew what that was. I ended up being the wellness advisor for most of my friends since 9th grade, helping them with the right exercises and diet advice. Although medicine was part of my life as early as that, it was not till my last year of High School that I finally made up my mind and went for Medicine. In fact, it was going through the pages of the book Siddhartha, that I made my final decision of moving away from my family business tradition and chose probably the harder and most rewarding path that I could take.
Can you share the most interesting story that happened to you since you began your career?
Many lessons, many stories but one of the most important and earliest lessons I have ever learnt was that medicine is not only about fixing a problem but helping and empowering the patient to become the best version of themselves. During the first year of my first Residency in Internal medicine in Venezuela, I had a patient under my care scheduled for an echocardiogram that morning and the elevators were broken. The patient was in his late 60’s, his room was on the 8th floor. We really needed the test to determine if the patient should get a heavy load of antibiotics for a possible infection inside of his heart. He was stable but weak. I was determined to get the test done, so I told him to get in the shower dressed up like we are going out and let’s get this done. So, he did. I helped him come down the stairs, which probably took us 30 min or so, as I made him take frequent breaks while bantering through the hospital. We finally got to the Cardiologist’s office on the first floor. While he was sitting on the stretcher, I noticed the neck of his shirt was bent and I naturally fixed it, as I would do with my dad. The cardiologist was looking at us astonished. He asked the patient: — “How come you look so good today when it was just yesterday when I saw you laying on bed, looking so sick? You have groomed yourself so well, I love it. Patient answered: Of course! I must look sharp, Dr. De Freitas told me to get ready, because we are going out. Just her energy and determination of getting things done the right way made me feel better. I felt like I had a date with life, so I did dress accordingly.
The cardiologist looked at us and said that this was the best example of what a Patient-Doctor relationship should be. Then he looked at me and said: — You, my dear, so young in your career have made this patient better with your care and love, proving that our main job while taking care of people is not to make them feel better with medication but to empower them to become the best version of themselves.
Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?
“Love heals”, this is my favorite life lesson quote. This has been so relevant to me throughout my professional and personal life in so many ways. I really have worked hard to achieve this. I must go through burnout, frustration, and pain , but that forced me to look for tools to heal and, in that journey, I developed different therapeutic strategies that have become essential to enhance all my medical and biomolecular therapeutic protocols. For me medicine is not my job, it is my joy. Because of the work I must do to heal myself, I developed a formula to generate and share love with every life I get to touch. I made that my mission because I recognize that bringing loving energy to my interactions with patients helps them to heal faster and get better results from all the therapeutic interventions we do. That is how this life lesson quote changed my life, becoming my main driving force for change in medicine.
None of us can 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?
So many people, it is hard to choose who each one of them has been a mentor and has shared lessons with me that have embedded in my DNA but if I must choose one story, I think I will choose my mom’s one. This is a story I am also sharing in my upcoming book “Beyond Well.”
During my second year of Medical School, I got sick with Epstein Barr Virus. I got a fever, hepatitis, and severe fatigue. I was also taking my finals, so it was a stressful time for me. I ended up developing Chronic Fatigue Syndrome and I gained 15 lbs. all together. I felt terrible, I could not exercise, and I got depressed. One day my mom sat with me and told me seriously: -Dear, your main job now is to learn how to fix yourself, because you cannot heal anybody if you do not know how to heal yourself. So, stop worrying about all those things you need to learn and start learning from your own healing experience. Therefore, I listened, and through that loving reminder I got from my wise mom, I reconnected with myself and my own health.
Ok wonderful. Let us now shift to the 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?
When we meet people in real life, you perceive the person with all your senses and they are perceiving you. The therapeutic experience is enriched or affected by all those energies.
One of the lessons I have learned in all these years of practice is that “bedside manner “encompasses multiple emotional elements that have very little to do with how sharp we look or sound and the skill we display with our physical examination skills, and a lot to do with how compassionate and empathetic we are with the patients’ needs and feelings. Like in any relationship, how the doctor makes patients’ feel tends to be as, if not more, important than whatever the doctor has to say or do.
Having the patient in the same space allows that exchange to occur more naturally, enhancing the therapeutic experience, bringing it up to a higher level, especially for those doctors who have the fortune to practice with empathy and compassion.
When the patient is in front of us, we can examine them better for the diagnosing/healing experience. However, as technology has enhanced virtual meetings, we can get a lot of useful information without the need of having the person in front of us. Physical exams have become less crucial as more accurate diagnostic technologies have been developed, like cardiac rhythm monitoring on your mobile phone and blood pressure and blood sugar apps and virtual encounters are becoming more realistic with the use of heads-up display (HUD) that patients and doctors wear to transport you to a virtual space where both are on the same room. This is helping to break some of the limitations we have today.
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?
When the patient is not in the same space as you, it is like when you are talking to your mom on the phone. You can still perceive her energy and it can even make you feel better, but nothing like hugging her in person. Physical exam and observation that we usually make by just looking at the way the patient walks or moves on the stretcher are not possible using telehealth. Comforting and sharing bad news becomes, in my opinion, much harder when the patient is not in the same room as well.
I like to see my patients in person at least once a year and get them in the same space than me. Maybe I am just being a little old school on this. Perhaps with the progress of the technology this will change too. But for now, I had that as one of my key rules included in my company and clinic values.
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.)
- Choose a zen place to do your televisit.“Telehealth manners” are important and valuable, looking at the camera and not just the video display of the patient, is key to interacting effectively with a patient over a screen and making them feel safe and comfortable. Avoid interruptions and be present. Doctor-patient relationships are all about establishing rapport, developing trust, and making a patient feel relaxed. Making eye contact, listening carefully, giving them providing them a space for openness and present are key for this to happen. I actually have installed a pair of “googly eyes “near my computer camera to remind me where to look.
- Understand your limitations.It is important to understand your limitations when you are not interacting with patients in person. Sometimes patients expect that we are going to save them a visit to the ER and in fact that is exactly what they need. I hate when that happens, but it happens often, and patients are always trying to convince you that they do not need to go to the ER. I always try to be honest and explain to my patient what I am thinking. Sharing with them my reasoning has helped me gain their trust and respect and feel more participative in their own medical-decision process.
- Understand their limitations, make sure they are following you and understanding the information shared. Translating my thoughts into simple language and speaking slowly and clearly for your information to be absorbed by them. I also try to ask questions like: I just want to make sure that I am clear. Would you please tell me what you understood from my conversation? So, I can make sure I have communicated effectively.
- Let the patient end the visit first— As in an in-person visit, it is important to allow the patient and family caregiver to ask any questions they may have. Before ending any encounter, I also ask patients if they have any questions and I even give them a chance to think for a minute if there is anything they want to ask before ending the call. This allows them the chance to voice any concerns I might not already address before the end of the visit. I also invited them to text me if they think of something else after we finish, as I know from previous personal experience, we often remember questions we should have asked after we leave the meeting.
- Send lab results ahead of time, if appropriate. It is usually very helpful if the patient has already gotten their results and has them opened in their computer or printed, so they can take notes and ask you questions after looking at the labs. This has worked miracles with my patients, beside they feel they are being included into the analysis of the data and decision-making process which empowers them.
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?
There are many benefits that telehealth visits have brought to my practice. It is easier to see my patients more often, facilitating monitoring and adjustment of their therapy and plan in real time. I am also able to monitor their blood pressure, weight, blood sugar and heart rate by using apps that allow them to share their readings with me. Nowadays, most of my lab results interpretation happens virtually and therapeutic adjustments are made with no delays because of that. I have also had the opportunity to join some of my patients when they are seeing another specialist, creating the opportunity to brainstorm and share ideas, in a real multidisciplinary patient-centered approach.
Let us 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?
Although simple, I really think that all the platforms that allow video conferences in general are tools that have facilitated and enhanced virtual encounters. The fact that we can see each other on a screen while having a conversation and share the screen and show patients their las results, develop a plan of action and go over with them is so helpful. I also love the new apps that allow me to see graphics of their blood pressure, physical activity, weight progress and even mood and spirituality for those of my patients that are trying to incorporate spiritual practice into their regular routine to help them manage stress.
If you could design the perfect Telehealth feature or system to help your patients, what would it be?
I would say, something as simple as HIPAA compliance facetime. Where just with a simple phone call the patient can get into the virtual video conference space. The simpler we make it for them, the easier we will get them to enjoy the benefits. The advantage we have today is that patients of all ages are very familiar with FaceTime, WhatsApp and Zoom. So, all the systems should be be created in a similar model. The reason why I said this is that I have noticed that many systems used by big hospitals tend to be more complicated. Not sure why, but some hospitals have chosen technology that makes Telehealth more challenging specially for our senior patients, but also annoying to our younger, tech-savvy ones. I guess as the Telehealth movement continues growing, platforms will improve, and this challenge will be overcome.
Are there things that you wish patients knew to make sure they are getting the best results even though they are not actually in the office?
For the televisit to be effective patients need to understand that this is a real consultation, so they need to prepare for it as they prepare for a real visit to the office. Have a list of their concerns and questions, a list of their medications and take the call in a quiet and private place. By having the benefit of seeing your physician while you are at home, allows them not only to save the driving and the inconvenience of going to an office, especially during the pandemic, but also allows them to be more relaxed, some patients experience significant stress or anxiety at a medical setting such as a doctor’s office. This may manifest in a higher chance of missing to share important information and having more difficulty understanding data shared at the visit.
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?
The use of extended reality for pain and stress management really gets me excited. The simple idea of being able to provide neuro-behavioral interventions that allow patients to get the physical and emotional benefits of these therapies, without moving from the comfort of their home for me is just amazing and very promising.
Is there a part of this future vision that concerns you? Can you explain?
We must make sure that as technology and AI take over and some of our therapeutic responsibilities are taken away from us, we do not forget or underestimate the key role played by the human touch. Mounting evidence proves that love and empathy have a key role in an individual’s health and wellbeing at a biomolecular level. We have a promising future ahead of us, if we do not forget how important it is to keep love and human touch as a key part of any therapeutic plan, algorithm, or equation.
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 have been working in a platform designed to deliver personalized innovative medical protocols based on algorithms that translate online comprehensive questionnaires and advanced biomolecular testing results. I envision that this platform will allow us to escalate data gathering and decrease medical errors while maximizing the quality time during the encounter and improving doctor-patient relationship journey.
How can our readers further follow your work online?
Thank you so much for the time you spent doing this interview. This was very inspirational, and we wish you continued success.