Create the right environment. Taking into account the types of patients you treat, pay attention to the surroundings the patient will see. Make sure the area is clean and free of clutter, as well as personal and private information. Ensure there is an interesting and visually background with minimal distractions. For example, my home office is set up with inspirational quotes and butterflies on the wall behind me. I also usually have soft music playing to create a relaxing atmosphere.
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 Valerie Carmel.
Valerie Carmel is the CEO of Valerie Carmel Therapy, LLC and is a Licensed Clinical Social Worker, Author, and Speaker. Her completely virtual practice provides treatment for a wide range of mental disorders in Florida and Nevada. As a proud alum of Florida State University and Florida International University, she has almost 20 years of therapy experience with additional certifications in telehealth, anxiety and trauma. She is passionate about her mission to support Black women to take control of their mental health to transition from surviving to thriving, as she shares her own transparent journey of living with anxiety.
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?
Sure! I’ve been a therapist for almost 20 years and have struggled with my own history of depression, miscarriages, and basically just life. In 2019, I got a promotion at my 9–5, wrote a book, and launched my business all while being a single mother. On the surface, I was crushing all my goals but it wasn’t until I started having panic attacks that I had to face the truth. I was taking care of EVERYONE better than myself and needed to take my own advice. So, I started to take control of my mental health and realized how many other Black women were having similar experiences but were too embarrassed or scared to talk about it. I decided then to be transparent about my struggles to reduce the stigma of mental illness and provide tools, knowledge, and support to other Black women to thrive.
Can you share the most interesting story that happened to you since you began your career?
Several years ago, I had lost my job and took a position I didn’t really enjoy but needed the money. It was mentally and physically exhausting, as it was far away from my home and I had to drive around doing therapy. I was pretty discouraged and frustrated with the state of my life, but every day coming from the job I HATED, I would see the billboard of the place I really wanted to work. Every time I drove past that sign, I would say “that’s where I’m going to work”. This went on for months until one day at a community Halloween event I ran into someone I knew who worked there. I went over to hug her and the first thing she said was “Do you live here now because we need a social worker!” A few weeks later I started working there and stayed until I relocated to another part of the state. I loved working there and I still maintain many of those friendships to this day.
Can you please give us your favorite “Life Lesson Quote”?
There are so many but one of my favorite quotes would have to be “grow through what you go through”. Can you share how that was relevant to you in your life? I’ve had my share of struggles just like everyone else. I’ve lost my job, had multiple miscarriages, dealt with insecurities and doubt, experienced depression, loss my dad, and manage anxiety and panic attacks. Any of those situations could have made me want to give up on my dreams and myself. But then I remember, rain falls on the just and unjust; NO ONE is exempt from hard times. I have used my faith and journaling to create a wellness routine. My pillars are self-awareness, self-care and self-growth. Together, my focus on these 3 areas enables me to experience consistent personal growth and be prepared for future successes.
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?
Although there are so many people, professionally that would be my friend Tara. Can you share a story about that? Until about a few years ago, I hated public speaking, but Tara saw a talent in me that I didn’t see in myself. She pushed, annoyed and pretty much “voluntold” me to speak at a trauma conference. Since then, I have presented and trained so many other people within non-profits, at professional conferences and more. Without her encouragement, I never would have challenged myself.
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?
Well, for one familiarity. Historically, we have done most of our interactions with people in-person and understand the social norms and etiquette expected. In addition, in-person visits allow you to observe more of someone’s body language and behaviors. With about 80% of our communication being non-verbal, being in-person helps you catch more of those nuisances.
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? I think the biggest challenges have to do with the loss of control as it relates to distractions, privacy, and technical issues. Virtual interactions require a focus on 2 separate environments, yours and the patient’s. While you may take all the necessary steps to manage these issues on your end, you have no control over the environmental factors around the patient. The patient could be meeting with you in their car and the connection is spotty. The patient could be talking to you in a public setting (like work, coffee shop, etc.) where their protected information may be overheard by others. They might be at home with its own set of distractions like family, pets, chores or Netflix.
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 ? I think this would be the most important 5 things to know:
- Create the right environment. Taking into account the types of patients you treat, pay attention to the surroundings the patient will see. Make sure the area is clean and free of clutter, as well as personal and private information. Ensure there is an interesting and visually background with minimal distractions. For example, my home office is set up with inspirational quotes and butterflies on the wall behind me. I also usually have soft music playing to create a relaxing atmosphere.
- Take privacy seriously. Be mindful of potential ways their protected health information could be inadvertently shared. Think about the different ways someone could potentially see or hear the patient. I have my laptop facing away from my office door, lock the door during sessions, advise my family of my unavailability to reduce interruptions, wear earbuds during session so the patient can never be heard and music playing also helps to muffle my voice to my family outside my door. I also make it a point to NEVER keep anything with the patient’s name or information in my office.
- Know the laws and rules. Telehealth is still an evolving practice and so it is your responsibility as the provider to be aware of the laws and rules which govern your practice. Keeping abreast of this will minimize the risk of violating the rules as well as making sure you can educate patients about the rules. One such rule I must adhere to is my patient must be physically in the state where I hold my license. I make sure to let my patients know this in advance so when they travel out of state, they can make appropriate accommodations like rescheduling or cancelling their appointment.
- Prepare your patient. Not everyone is well versed in having virtual appointments and this can cause some anxiety or apprehension. I take time out during the very first session to discuss with the patient what to expect, ways to minimize distractions, what I am doing to protect their privacy, review the different icons on their screen, acknowledge any worries they may have and allow them to ask questions. The goal is to ensure they are comfortable because the more comfortable the patient feels, the more likely the visit will go well.
- Have a backup plan. Inevitably something will go wrong. Prepare for this in advance and make sure the patient knows the plan. I have a client that during the session her internet service went out due to a storm. I waited a few minutes to see if she would log back on and when she didn’t, I called. She answered on the first ring because she knew this was the plan. The session was able to then continue as scheduled without any more issues.
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 biggest benefits have to do with an increased variety of providers and convenience all due to travel no longer being a barrier to care. Traditional in-office visits required you to travel to the provider, which takes up time, gas, and the stress of traffic. It also limits the providers available to you as distance will affect your selection. However, virtual visits completely remove these barriers. This allows my female Nevada patient to still meet with me weekly while I reside in Florida.
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?
A great webcam and earbuds! My laptop comes with a webcam but I purchased another one and use earbuds which makes my picture and sound clearer. This makes it feel as if my patient is in the room with me.
If you could design the perfect Telehealth feature or system to help your patients, what would it be?
To have a feature where a virtual assistant/IT person that pops up to engage in small talk with the client while they wait for their appointment to begin and respond during the session to address any technical issues.
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?
Patients should be mindful of the time and place they will be when having their appointment. While flexibility and convenience are important benefits of telehealth, certain environments aren’t conducive for the private nature of meeting with their provider. Ensuring they can minimize distractions and interruptions will be important, as well as a strong Wi-Fi signal.
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?
As my focus is on working with anxiety, AR provides a great opportunity to conduct sessions in different settings where the patient could be gradually exposed to their fears or phobias as part of treatment. This would be especially powerful for people with social anxiety, agoraphobia or experiences that are difficult to be recreate, like the fear of flying (aerophobia). It also would be amazing to change the setting in which my appointments are done, so I could have appointments at the beach, the woods, or with a city skyline all in one day.
Is there a part of this future vision that concerns you? Can you explain?
Definitely, because too much of a good thing is usually a bad thing. The use of technology has so many great benefits, but I do worry it will create an overdependence on virtual spaces that we will lose our desire for physical touch and close contact with others.
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. 🙂
It would be to inspire Black women to openly discuss and care for our mental health. We are a rapidly increasing demographic of people experiencing significant mental and emotional distress due to racism, police brutality, health disparity and the wage gap. As women we are giving birth and raising the next generation of people who will populate this Earth and effect change. By removing the stigma of mental health, we not only will heal ourselves but prepare the subsequent generations to do the same.
How can our readers further follow your work online?
Readers can find me on Instagram @thevaleriecarmel, Facebook at Valerie Carmel, and my website here, where I will be launching my blog this summer.
Thank you so much for the time you spent doing this interview. This was very inspirational, and we wish you continued success.