Obviously make sure technology on your end is working and optimized: Generally I start my mornings about 10–15 minutes earlier to make sure your camera and microphone are in good working order. I typically ensure that there are no issues with the internet and have another laptop/backup mechanism if one of those were to fail. I generally have one screen so I can see the patient fully and a laptop so I can work on notes and prescriptions. I also generally explain the set up to the patient and ask if it is okay if I type during their interview.
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 interviewingDr. Sasha Hamdani, MD.
Dr. Hamdani is a Board certified psychiatrist and ADHD clinical specialist. She completed medical school at the 6 year accelerated BA/MD program at University of Missouri Kansas City. She completed three years of residency training at University of Arizona and a final year of training at University of Kansas Medical Center. She currently practices at Psychiatry Associates of Kansas City.
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?
My mother is a beloved pediatrician in my hometown so I grew up knowing I wanted to do medicine. When I entered medical school I knew I wanted to do pediatrics but didn’t know what I wanted to specialize in. As I ran through all the possible pediatric specialties, I did a rotation in Child psychiatry and fell in love with it. The more I explored psychiatry, the more I felt drawn to it. Now I have been practicing in this field for almost a decade and couldn’t be happier with that decision!
Can you share the most interesting story that happened to you since you began your career?
Honestly, with psychiatry everything is an interesting story. It is fascinating to be able to help navigate people through these complex parts of their lives.
Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?
Rumi once wrote “Live life as if everything is rigged in your favor.” I think so often we allow our own insecurities or fear of failure prevent us from living to our true and complete potential, so this is such a beautiful reminder to tread bravely into your journey.
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?
My medical school journey was difficult. It was the first time I was away from home and I transitioned from being a big fish in a small pond to being a very mediocre, tiny fish in a seemingly enormous sea. I previously let my academic acumen define me as a person, but now I was surrounded with people with similar (if not superior) accomplishments. The person who constantly kept my hope alive and would work with me tirelessly (even if it were something he didn’t initially understand) was my father. I wish they could have given him an honorary MD as that guy can now explain the inner workings of a kidney to perfection.
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?
Psychiatry is an interesting field. We attempt to correct underlying neurobiological imbalances but very rarely do we have information other than subjective interviews from the patient. We primarily base our assessments from what and how the patient is giving information, so we are one of the few fields of medicine that perhaps could transition to telehealth. However, there is nothing replicable about the rapport you can generate by seeing someone in person. Furthermore, in person visits allow you to provide minute to minute aid depending on what is going on (I have passed people tissues and I have responded to seizures both during in person visits).
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?
Some of the challenges from the patient not being in the same spot is the doctor is that it might be hard to read those nonverbal cues: body positioning, physical signs and symptomology, and appreciable changes in demeanor. That can sometimes be difficult to assess via telehealth. Perhaps even more difficult is building rapport with a patient who is accessing you via computer screen. Usually they are discussing complex medical issues or deeply personal psychological factors and it can be hard to respond appropriately if you can’t hear them appropriately, or if technology is glitching, or if you simply can’t physically communicate or show that you are actively engaged in what they are saying.
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.)
- Obviously make sure technology on your end is working and optimized: Generally I start my mornings about 10–15 minutes earlier to make sure your camera and microphone are in good working order. I typically ensure that there are no issues with the internet and have another laptop/backup mechanism if one of those were to fail. I generally have one screen so I can see the patient fully and a laptop so I can work on notes and prescriptions. I also generally explain the set up to the patient and ask if it is okay if I type during their interview.
- Making sure you are prepared to visually present: Make sure the lighting is adequate, the camera angle highlights your face (and for me, I gesture wildly with my hands so I make sure that is showing as well). I also try to be mindful of what I am wearing and keep it relatively plain and neutral so it is not distracting or take up too much bandwidth.
- Consider the patient’s individual needs: A lot of my patients are well versed with telehealth at this point, but some are using it for the first time. I generally have my medical assistant provide them written instructions (and brief potential trouble shooting prior to their appointment). We also need to take into account if they have any impairments or need any additional assistance (interpreters, additional family members, or additional resources to help them with the technology). Some platforms have those accommodations built in (closed captioning, adding another user like an interpreter, modulating the volume on your end for hearing impaired).
- Establish a “webside manner”: This is a little different than bedside manner in that it may be a little more difficult to establish rapport, develop trust, and make a patient feel relaxed in a virtual visit. Generally I address this head on and say that “this is an odd setting but we will work together to make sure we make this as seamless as possible.” I also vocalize things that perhaps I wouldn’t be able to do virtually, “I know you’re upset. I know this is isolating and this was an in person visit I’d be handing you a tissue right now. Let’s pretend I’m doing that!” Generally acknowledgement of this with that little bit of levity helps.
- Let the patient end the visit first: One of the things I have heard from patients is that the call ends abruptly and they don’t get “closure” from the visit. To prevent that I generally end the interview with setting up another appointment, asking if there are any additional questions, and ending you “I’ll go ahead and let you end the call when you’re ready.”
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?
Telehealth has actually been wonderful for some people that could not break away from their schedules to drive to the appointment, wait in the waiting room, attend the appointment and drive back. It has been a tremendous time-saver in those circumstances. We also serve a lot of rural communities that sometimes have a 4–5 hour drive for a 15 minute appointment. Now patients don’t have to seek out childcare or bring their children with them to appointments. Finally, there is something unique about being in a situation where the patient has control over the environment that they want to show to doctor. Often times I get to see patient’s in their homes and this is a unique experiences and actually enhances the ability to build rapport.
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?
One of the best things I have seen is a virtual waiting room. This is a fantastic way of transmitting information to a patient prior to the appointment. In terms of replicating the experience of an in-person visit, superior video and audio quality are perhaps the most important features to look for in a platform
If you could design the perfect Telehealth feature or system to help your patients, what would it be?
I am no expert in this and feel as though we are very close to a full potential system. I would just want it to be more consistent, better quality, and FASTER.
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?
Test your technology prior to visit. A lot of platforms have that option prior to the appointment. Secondly, I generally tell people to go into the appointment prepared with what they want to discuss, that was if technology is being “glitchy” at least we have attempted to discuss what is most important first.
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?
I don’t think I know enough about what is coming down the pipeline. Every time I have used VR I have felt acutely nauseated, so the hope is that we progress past that (although that might just be a ME problem).
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 would hope that we use this unique time where there have been leaps and bounds in providing technology and access to care to people that we can further find a way to make mental health resources available on these platforms. A big barrier to care is the fact that a lot of psychiatry is still very stigmatized, so telehealth permits a more appropriate privacy and safety to address those concerns.
How can our readers further follow your work online?
They can access my website at drhamdanimd.com or follow one of my social media accounts on instagram or TikTok as thepsychdoctormd. Those primarily focus around ADHD awareness and management.
Thank you so much for the time you spent doing this interview. This was very inspirational, and we wish you continued success.