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I admit I’d been among the skeptical ones — a technology hold-out in a sea of technophiles. I still have a VCR. Zoom sounded like a children’s board game; so did Venmo. And, needless to say, conducting my private psychiatry practice online was nowhere on my radar. But in March, everything changed.
With the reality of the pandemic hitting me in the face, I was forced to choose: close my practice or see my patients virtually. Because my 200 patients still needed access to their psychiatrist and might have staged a mutiny (to put it mildly) if I closed up shop, I chose the latter option.
Here is what I’ve learned along the way:
I Can Still Hear (and See) You
Having a video component in telemental health is crucial for me. Conducting sessions on the telephone can be valuable, but too much information might be missed. Even though you — the patient — are now a two-dimensional image, I’m careful to observe the subtleties on screen. In fact, I am taking everything in: your environment, attire, facial expressions and movements. In turn, I’ve received positive feedback from my patients. Most have expressed satisfaction with the quality of our virtual interactions, and have felt empowered to speak freely during a session.
Be Comfortable — But Not Too Comfortable
I know you want to feel comfortable. But lying in bed while participating in a session might be a bit too casual. Ditto walking through your house while holding a phone … or eating. I’ve had the occasional patient appear in a bathrobe or pajamas. So I want to be clear: Our meeting is a part of a professional contract — not a get-together between two friends.
According to healthcare attorney Nan Gallagher, “Patients should be mindful that now the doctor is observing you in your home setting, on your home turf, and is entitled to draw inferences based upon what he or she observed.” The inferences can have diagnostic and treatment implications — especially if I’m meeting you for the first time over Zoom or Doxy.me. Take care to set up your phone or computer in a neutral, private space within your home. You don’t want your sibling, parent or spouse inadvertently listening in on your session.
There Are Some Perks
First the obvious: You can’t beat the commute ... or the parking convenience. Probably because of this, the frequency of cancellations in my practice has dropped dramatically. But there are numerous less obvious advantages for the patient.
Jay Shore, M.D., chairman of the American Psychiatric Association’s Committee on Telepsychiatry, refers to virtual treatment as a “patient-centered approach.” Take a patient with social anxiety disorder, meaning someone who fears judgments while interacting with others. “Video conferencing is great to start with because the patient is comfortable and you have less threat,” says Dr. Shore. The therapist can encourage the patient to slowly emerge from their comfort zone in incremental steps.
New Jersey psychologist Dr. Naama Tokayer, who works with children and teens, agrees that telemental health can offer more opportunities for the patient. Dr. Tokayer says that when a young person has a session with their therapist from their bedroom, “their social media, texts, school assignments are right in front of them on their desks, which opens an opportunity to address the impact of an element of their life experiences that might not have come up during an in-office session.”
There Will Be Technical Difficulties … Maybe
Who hasn’t experienced the occasional screen freeze or Wi-Fi interruption during a conference call? Unfortunately, telemental health sessions aren’t exempt from technical glitches. And there has been quite a learning curve for technophobes like me. But there are things you and I can do to make a session run smoothly.
If possible, conduct a system check before signing onto a call with your doctor and be reassured that I will do the same. Technical difficulties don’t necessarily mean the end of a treatment session. Dr. Jane Sofair, a psychiatrist in private practice in New Jersey, says there are several options if a session is disconnected: “Maybe try to reconnect with them in telehealth, or it might be appropriate to hang up and give them a call.”
How a therapist chooses to respond to an interruption can add useful information about a patient’s tolerance for frustration or uncertainty.
The Future Is Here
Telemental health is transforming mental health care right now. But will it be a part of our future? The elephant in the room is the insurance company. Many, if not most, private and government insurers have expanded coverage during the pandemic to include telehealth services. But that might not be the case once the pandemic has ended.
According to Dr. Shore, an ideal future solution — albeit one that must be sanctioned by insurance — is hybrid care: “I think providers and patients will want to have more of a blend … still do some in-person and also do some video. You’re holding this relationship both in-person and in virtual space, and using a whole set of technologies to do that.” Patients and providers might decide together who would benefit from in-person vs. virtual vs. hybrid care. And this could be an important step towards more personalized and satisfying treatment.
