The Illusion of Eye Contact with Telemedicine
To create the appearance of eye contact, don't look at the patient
I’m big on eye contact with patients. It’s how I show myself as a human. The eyes are the windows to the soul. Through them, we build trust, empathy and reciprocity.
When I’m with a patient face-to-face it isn’t always possible but I do my best.
Like the IRL experience, I try to achieve some level of eye contact during telemedicine encounters. But care through a screen presents challenges. The problem is that the only way to create that eye-to-eye connection is to look directly at my camera. This way I’m looking right at the patient. What they experience is me connecting directly with them in the most human way. It hopefully serves as an indicator of my focus and bandwidth.
According to a September 2022 study in the International Journal of Medical Informatics, when physicians looked at the camera, they were perceived as making more eye contact and, in turn, received higher communication skills ratings. It seems some of this is culturally determined as well. So there’s that.
The problem is that telemedicine eye contact is an illusion. Because I can’t see them. All I see is the lens of my camera in this case. Appearing in the margins of my lower field of vision is the mother’s face and the critical cues of her reaction to the things I say. Sometimes I act like I can see with affirming facial expressions. But it’s part of a friendly charade to make the whole thing look real to the family on the other side of the screen.
And, of course, trying to record your note during the telemedicine visit adds a whole other layer of disconnection.
Now there’s the real possibility that if I were to look directly at them on the screen then people would see this lower focal point as actually being eye contact. A kind of detached focal point – a surrogate for IRL contact that the receiving person fully understands. A new kind of human understanding for 21st century connection.
I’ve heard there’s technology where a microcamera dangles down in the middle of the screen. It allows you to see the person on the other side while they see you looking directly at them when they speak. Maybe that’s the answer.
Technologies that mediate human connection compromise how we see and experience one another. Invariably, something gets lost. As we adopt new tools we have to weigh the benefits with what we surrender. Of course, the benefits of improved access for the single mother of a patient living 4 hours from my clinic typically outweigh the cost of a less-than-perfect encounter.
Where do you look during your telemedicine visits? I’d be interested to hear from both health professionals and patients
Photo by Sebastian Unrau on Unsplash
Non-doctor perspective here. This is really interesting. I haven't yet experienced a telehealth visit, but during other video conversations and meetings, one is aware of the disconnect between looking at the camera and looking at the other person's face. If I see someone looking at the camera, I know they're not looking at my face. I would actually be a bit uneasy if a doctor was looking at the camera during a telehealth visit because I'd want them looking at me instead.
I had a foreign GP some years ago at an office in a large medical system. I really liked her at first, partly because she would come into the exam room, get set up, and then just sit and look at me intently for a bit without saying anything (before the poking and prodding began). I felt quite observed. I had her full attention. Over the years, as she became captured by the system, she spent almost all of the visit time typing away on the computer. She would then do a hurried exam, never making eye contact and then swoop out to her next 8 minute appointment.
I do a lot of telehealth cardiology visits since moving part time to San Diego.
I've noticed that when I'm using my 27 inch IMAC for such visits if I don't put the "patient" in the middle of the screen, right below the camera, it does look like I'm not looking at them so I often make that adjustment.
I tend to "read the room" in terms of how much time I spend "looking" at the patient versus time spent pulling up an imaging report or recording what they are saying in a note, etc.
The patient that is clearly not looking at the screen most of the time gets little of me looking back.
With a new patient I want to spend a fair amount of time interacting with them visually.
In general, with telehealth I have more time to spend per visit and I spend more time talking about things that aren't directly related to patient care and during those times I am looking directly at the patient and evaluating response, etc.