Be more flexible and offer broader access to care. Telehealth allows patients to not have to switch providers if they move, giving them the opportunity to continue to build on the relationship they already have with their provider and avoid having to “start from scratch” with a new one.
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 Tammy Nguyen, PharmD, a graduate of the University of Southern California, has over 20 years of experience helping patients with their health care needs. She is the pharmacy site manager at Genoa Healthcare, a leading pharmacy services provider for people with behavioral health and other complex, chronic health conditions. The pharmacy is located onsite at Progeny Psychiatric Clinic in Irvine, Calif. Nguyen specializes in serving people living with mental illness and substance use disorder.
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?
Our pharmacy is located within a psychiatric clinic, so patients see us every time they visit their care providers and get to know us well. A long-time patient came to the pharmacy complaining of back pain that had spread to her hands. She tried pain relievers, anti-inflammatory medications, heating pads and alternative therapies, such as dipping her hands in rice. However, they only worked temporarily to relieve her pain.
She had been told that her back pain was due to her age, and that her hand pain was from carpal tunnel syndrome. She even had surgery on both her hands. Knowing her relatively young age and her daily activity level — she didn’t work on a computer or practice other repetitive activities — I suggested she see a specialist and get an MRI scan. Because we had developed a trusting relationship over time, she took my advice. It turned out she had bone marrow cancer that had spread through her spine and arms.
Fortunately, the cancer was caught early enough to do chemotherapy and a successful bone marrow transplant — and she is doing well today. It was truly gratifying that because of our longstanding relationship and personal connection, I was able to help her get the care she needed to get well.
Can you please give us your favorite “Life Lesson Quote” and share how that was relevant to you in your life?
“Little things make big days.”
Simple small actions can make the biggest impact. We send out birthday cards to all our patients to let them know that we care and are there for them whenever they need us. Once, a patient called thanking us for his card, saying it was the first time he had ever received a birthday card in his life. It is incredible how such a small kindness, like a birthday card, can make a huge impact on someone’s life.
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 aunt guided me to be the best person and pharmacist I can be. She was a pharmacist for the research department at the City of Hope, a hospital and clinical research center in California. She inspired me to never give up, work my hardest until the task is complete and be compassionate to others. She is no longer with us, but I keep her picture on my desk to remind myself to strive to be like the amazing person that she was.
Can you articulate for our readers a few of the main benefits of having a patient in front of you? 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?
Many of the people I see are being treated for serious mental illness and substance use disorder. There is a natural, personal connection when you are interacting face-to-face with a patient. And it is easier to build those all-important relationships, especially within the sort of critical and intimate care I am delivering, in person. In the traditional, face-to-face environment, I can check vital signs and weight, which is important for some medications. Assessments for signs of Tardive Dyskinesia, a movement side effect of anti-psychotic medications, are also much easier. Throughout the pandemic, Genoa pharmacy teams have made a big effort to maintain connections through texting and personal message platforms with our patients to ensure they stay on their medications and continue to have easy access to our team.
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.)
- Be more flexible and offer broader access to care. Telehealth allows patients to not have to switch providers if they move, giving them the opportunity to continue to build on the relationship they already have with their provider and avoid having to “start from scratch” with a new one. For example, one of our local California patients moved to Virginia, but continued to see his provider from our partner clinic and use our pharmacy for his medications. This ease of access allows the patient to maintain a trusted relationship with his doctor and our pharmacy.
- Research and establish a range of reliable technology that supports telehealth. An unreliable internet connection can make any telehealth appointment uncomfortable. Frozen screens or dropped calls inevitably frustrate the parties involved. It is also important to do your due diligence researching different video chat / conferencing platforms. As a pharmacy or provider, we cannot limit ourselves to a single platform.
- Prepare for the call. Review previous chart notes and reacquaint yourself with the patient’s conditions and previous complaints. Prepare list of follow-up questions for existing patients and guided questions for new patients. The patient is focused on your face the whole time and flipping around notes and trying to read their information on the spot can seem unprepared and instill a lack of confidence in the provider. The patient will feel that you did not care enough to prepare or remember them. As a pharmacist, when I engage remotely with patients treated for severe mental illness such as schizophrenia or bipolar disorder, it is incredibly important that I’m prepared for telehealth calls. Ensuring patients are staying on their prescribed medication plans can mean the difference between life and death.
- Ensure your at-home or in-office setup is camera-friendly. Good lighting is critical to consider as strong sunlight will wash out your face and make you difficult to see. It is also important to maintain eye contact throughout the session. Instead of taking notes on a note pad, consider typing your notes on the screen. Make sure your background is neutral and dress professionally. Looking anything but professional may cause the patient to question their choice in selecting you as their provider. Lastly, be punctual. Do not make the patient wait because as we all know, no one likes to sit staring at the phone, waiting for a call.
- Work harder behind the scenes to show you care. Telehealth may feel less personal for both the patient and provider. To compensate for the less personal feeling from a visit, show you care by working harder. For example, as a pharmacist, I focus on helping our patients get prior authorizations for their medications effectively and promptly approved. Then I call back to check up on them and inform them when their prior authorizations are approved. Keep connected to show you care, and that telehealth is just as effective as their in-person visit.
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 expanded access to care, especially for those unable to go to in-office visits due to physical disability, illness, fear of infecting others or being infected by others, lack of transportation or reluctance to go to a doctor’s office (especially in the mental illness field, where lingering stigma leads many to feel embarrassed about being treated for mental health care). Many community mental health centers in which Genoa pharmacies are located had to reduce programs, staff and foot-traffic for health and safety reasons over the past year, so many have moved to providing services via phone and telehealth platforms.
One of my closest friends has always been an easy-going, carefree person. However, the pandemic has caused her severe anxiety and frequent panic attacks. Her anxiety has gotten so bad that she is unable to go to work many days a month, has experienced insomnia for multiple consecutive nights and withdrew herself from her family. She was embarrassed to seek help for these issues. I connected her with one of the providers at our partner clinic via a telehealth session, and her mental health improved significantly, demonstrating the benefit for some patients.
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?
There are numerous telehealth platforms available, and some of the tools on our smartphones and laptops that have been effective and accessible during the pandemic are Skype, FaceTime, Zoom and Microsoft Teams. However, older patients and people living without smartphones, tablets and computers may not have those options. In addition to phone calls, Genoa pharmacy teams are finding all sorts of ways through these tools to maintain connections with consumers. My pharmacy is a big user of text messaging with the center’s health care providers to instantly solve issues with prior authorizations, refills, medication adjustments, etc., that in an average retail pharmacy could takes days or weeks to resolve.
If you could design the perfect Telehealth feature or system to help your patients, what would it be?
My perfect telehealth feature or system would provide a more personalized experience using holograms. Rather than connecting through a screen, holograms could replicate the life-like experience of an in-person appointment, allowing providers to better assess patients. Artificial intelligence (AI) would also aid providers by recognizing signs and symptoms on-screen for the provider to review. My dream is for AI in the clinical setting to feel like it was in the movie Iron Man — detecting and analyzing multiple things that the human eye cannot.
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?
For a successful telehealth session, patients should try to be as detailed and descriptive as possible when talking about their signs and symptoms. Current telehealth technology limits the provider from recognizing the non-verbal cues that they usually might notice during an in-person 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?
AI will be a game-changer for telehealth, as it has been for medicine at large. Similar to current technology for facial recognition, developers can create programs that tap into a plethora of data and utilize computing power to recognize and display symptoms that providers can miss on screen. One of the current challenges to telehealth is the limitation to what providers can effectively assess, i.e., signs and symptoms.
Is there a part of this future vision that concerns you? Can you explain?
Though technology has the potential to greatly impact and streamline the various challenges they solve for, we might see a decrease in social engagement. Our current society lives in an on-demand world. Almost everything is now available online and with the click of a button (or two), such as shopping, healthcare, books, movies, games, television, news, education. Children and adults alike have significantly minimized outdoor activities and social engagement, and this may lead to mental health issues such as isolation and depression, as well as hinder mental growth, especially in children.
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.
Going back to my close friend who developed the anxiety disorder and panic attacks from the pandemic, I want to inspire a movement for mental wellness awareness. Unfortunately, there is still a stigma and discrimination around mental illness that has held many people back from seeking the help they need. This has the impact of worsening their illness and quality of life.
We need to lead a movement that helps people recognize how common mental health conditions are. One in five people in this country has a mental health condition. These are disorders that can impact anyone and should be discussed without shame. People need to be aware of the importance of mental wellness and show empathy for those living with mental illness.