Make sure you continuously discuss your expectations with patients that video sessions are considered the same as any in office appointments. Remind them of simple things like being appropriately dressed, being in a private space, not driving during their video session, etc.
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 in order 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 Dr. Priyanka, M.D., Medical Director, Community Psychiatry:
Dr. Priyanka is a board-certified psychiatrist. She attended medical school in India and came to the United States in 2006 to continue her education. She first attended the Nutrition and Dietetics program at Syracuse University and then joined the psychiatry residency program at the University of Rochester Medical Center in Rochester, New York. She joined Community Psychiatry, California’s largest outpatient mental health organization where she currently serves as Medical Director. Her approach to psychiatric treatment is to consider the overall health of her patients and bring them along on a journey to understand the role of eating habits, exercise, self-care and mindfulness in their wellbeing.
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 a general adult psychiatrist working at Community Psychiatry for the last 8+ years. As I was going through medical school, there were only really two options I considered for specialization — surgery and psychiatry. And, as much fun as it was to perform surgeries, I ended up choosing psychiatry primarily because it allowed me the ability to work with patients over a longer period of time and make an impact in a field that has long struggled with access to quality care and stigma surrounding it. You can say that I like taking on challenges that seem difficult to solve. Since making my choice, I have appreciated and enjoyed my work in this field every day. The best part continues to be seeing a patient’s journey, when they go from having the worst day of their life to thriving in any situation life presents to them.
Can you share the most interesting story that happened to you since you began your career?
I have had a few experiences in which patients have surprised me with their ability to overcome the toughest of challenges. I wish I could share these stories, but I would need consent from the patients to fully describle what these patients went through and how they were able to remarkably still stand. I myself have learned a lot about the human spirit and tenacity working with these patients.
Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?
I have seen different versions of this quote, but here is my own twist on it: a person is not defined by the problems in their life, but by the way they chose to deal with those problems.
None of us are able to 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?
I truly believe that our success in life is truly built by small building blocks laid over years and years. I have been fortunate enough to have wonderful family, friends and coworkers who have influenced my life in meaningful ways as they have offered guidance, support and when needed a push for me to explore beyond my perceived limits. I have tremendous gratitude for everyone important in my life.
Ok wonderful. Let’s now shift to the main 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 I see patients in person, there is an almost automatic human connection. You do not have to work as hard as you must on a video call to make that connection. It is especially helpful to have a patient in front of you when they are dealing with stress in their life or have experienced something traumatic, as your empathy comes across more naturally. To me that is the biggest advantage of seeing patients in person. It is also easier to examine gait, mannerisms, tics/twitches and certain medication side effects. An additional benefit that is vital for some patients is that it gets them out of the house and participate in an activity that they would have avoided otherwise. In several psychiatric conditions, patients tend to retreat and isolate which only worsens their symptoms so having regular in person appointments has a therapeutic effect in more than one way.
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?
One of the biggest challenges I have encountered is when a patient is expressing safety concerns and you do not know exactly where they are. I have been in some situations when a patient on a video or phone call expressed suicidal thoughts without sharing where they were calling from at the time. Thankfully, these situations worked out well and patients are doing well at this time, but I still worry about not seeing patients in person when they express safety concerns. There is also limited ability to seek paperwork virtually, as some patients really struggle with completing forms and sending information digitally. When they are in the office, you can simply ask them to review and sign right in front of you. Another challenge is being overly reliant on technology, and as we know it does not work perfectly all the time. Lost connections, delayed audio or interrupted video streaming are still more common issues than I would like.
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.)
I have been a telemedicine provider for almost seven years now, long before pandemic made it a necessity. Over the years, there have been so many different experiences using telemedicine, so here are a few of the lessons I have learned:
- Always acknowledge the benefits and limitation of tele-sessions as early as possible in the course of treatment.
- Advise patients on the best ways to reach you if they need urgent help.
- Always obtain “in case of emergency contact” information in advance for patients who are seen via video sessions.
- Make sure you continuously discuss your expectations with patients that video sessions are considered the same as any in office appointments. Remind them of simple things like being appropriately dressed, being in a private space, not driving during their video session, etc.
- If a patient is not in the same geographic area as you, attempt to learn about resources in the patient’s local area so you can provide the best advice if they need additional referrals like therapy, psychological testing, support groups, etc.
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?
The ability to keep appointments as scheduled is a significant opportunity, as patients do not have to take much time off, drive long distances or wait for a while in the reception room. They simply log in at the time of the appointment and pretty much can go back to what they were doing as soon as the appointment ends. I had a patient who frequently needed to cancel or reschedule appointments before the pandemic, as she could not find childcare and her insurance did not cover telemedicine as a benefit. During COVID all insurance companies started covering telemedicine appointments, and so in the past year this patient has not missed or canceled an appointment.
The ability to see a provider who is a good fit for you is another area where I have seen tremendous progress. I had a patient who could not find a therapist specializing in OCD treatment, but with almost universal coverage of video appointments now, they have been able to find a specialist who works in a different city but can see them regardless. This patient’s insurance did not allow telehealth visits before COVID.
Some patients who are fearful of leaving their house or have a disability that makes it difficult for them can also access care from their home via a telehealth option. I had a patient who would have to be on a medical transport for hours to get to their appointment and informed me that on the day of their appointment it would take them hours to get ready, come to the office and then get back home.
Another interesting opportunity is being able to share in patient’s lives where they live. Patients have been able to make their family members part of the treatment more easily than they did when they had in-office visits. For example, I now get to see their kids, pets, hobby projects or patch of vegetable garden that they are working on. Patients get so excited about sharing that side of their life during video appointment as compared to when they come to an office.
Let’s 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?
The ability to share screen and send files to the patients has helped create an interactive experience. Usually you will be able to print out and hand patients information sheets, articles or worksheets, and in a virtual environment it can be simulated via sharing screen and file sharing. The waiting room function is another helpful tool that has allowed for a smoother transition in and out of the virtual appointments.
If you could design the perfect Telehealth feature or system to help your patients, what would it be?
I think if there is an option to record a summary of the session or homework assignment that can be pushed as a notification to the patient at pre-determined times to engage in the recommended activities or practice coping skills, that could help clinicians create individualized treatments that are not only limited to the session but can have a far reaching impact. Many times we lose the impact of therapeutic interventions as its not delivered as frequently as possible to the patient. This could even include notifications for the patients to take medications.
Are there things that you wish patients knew in order to make sure they are getting the best results even though they are not actually in the office?
Telehealth is shown to be very close to as effective as in person sessions. Patients should know that effectiveness of their treatment is largely driven by their understanding of their diagnoses, available treatment options and their ability to fully engage in the treatment plan of their choice. Understanding the risks and benefits of your chosen treatment plan should not be impacted by care delivery model, whether delivered in person or via telehealth platform.
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?
One of the things that I’m looking forward to is the ability to create multidisciplinary care teams that can deliver collaborative care virtually. Usually, it’s complicated for the patient to go to different doctors and for information to be shared with ease, unless the patient is already a part of a plan that has all the services available under the same umbrella. With wider acceptance of telehealth, we can create virtual clinics that have all services available for the patients and clinicians to share information without any need for faxing or mailing records. There is certainly talk on this topic, but I have not seen anyone being able to do this so far.
Is there a part of this future vision that concerns you? Can you explain?
Human connection might still be an important piece in mental health that we need to retain, and as technology advances further there is a risk that we are at a higher risk of losing the human aspect. Another issue might be with the patients who struggle to use or adapt to new technologies.
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 thinking a lot about preventative mental health care as the new frontier. We have not even caught up to the need for mental health care in the current state, so it is a little difficult to even think about preventative care and it may take us years to get to that discussion point. But there is a case to be made that if we were able to implement preventative strategies to allow people to proactively build strong coping skills, engage in self-care activities and be able to recognize early warning signs of mental health issues, we would likely be able to decrease symptom burden and improve overall quality of life. Since telehealth has the ability to reach a larger number of people at once, it is a wonderful platform to introduce some preventative measures. Some of that work is going on with mindfulness apps, but most of the work is still simply focused on treating symptoms.
How can our readers further follow your work online?
You can find my page here: https://www.communitypsychiatry.com/providers/dr-priyanka-m-d/
Here are some recent articles and videos of mine to learn more: https://www.psychiatrictimes.com/authors/p-priyanka-md
Thank you so much for the time you spent doing this interview. This was very inspirational, and we wish you continued success.