Is Telemedicine and/or Teletherapy a Good Idea? Part I | Dierich M. Kaiser, MD, Diplomate of the American Board of Psychiatry and Neurology and Western Tidewater Community Services Board

As a practicing psychiatrist, I have had numerous opportunities to practice by use of telemedicine/teletherapy platforms.

For obvious reasons, these platforms have grown immensely in popularity since the COVID-19 pandemic. Patients and caregivers needed to isolate while still moving on with mental health treatment and practice, respectively. Telemedicine was the obvious answer.

Since the suppression of COVID-19 as a health crisis, telemedicine has remained very popular. And why shouldn’t it be popular given how easily computers, cell phones, and the internet allow people to communicate?

Telemedicine commercials make it look like seeing a doctor is almost as easy as face-timing a friend. The convenience is enticing. And upstart healthcare businesses know that and intentionally make the process look quite easy.

Another aspect of this trend is the concept of control. Patients feel empowered by care platforms that get them in touch with a caregiver quickly and without leaving their home. Patients can pick from different providers and pick times at which they want to be seen. People in small towns used to be limited to whatever provider was reasonably available. That is no longer true. We have entered into a new world of easy access to mental health care.

My experiences have also shown me that caution is indeed necessary as we move forward with telemedicine. We have learned through life that things which come too easily may be deceptive and need to be scrutinized before they are trusted.

Patients and providers need to do the work required to understand their needs and limitations. Patients need to get a feeling for their options regarding various care platforms and then scrutinize any care platform to see how it works and what other patients have experienced with it. Please do your homework and ask questions – many questions. Such as: Do you take my insurance? How much will this cost? How are payments made? How often can I see my provider? How do I know my provider is qualified? How often do your company’s providers leave the platform? Are there limitations regarding certain types of care? Will my provider be able to assess for, and treat, the condition that I feel I have? Will they prescribe the medicine that I need or want? Can I switch to a different provider if I don’t like the one assigned to me? If the platform has problems, can I just talk to my provider by phone? Please make sure that, as a patient, you feel comfortable and cared for as you move forward with your telemedicine experience.

Telemedicine providers need to make sure their patients are as fully aware as possible of the parameters of the relationship. Providers should check on the status of their patients with the above questions in mind. Those questions may need to be revisited in order to flesh out important details. If you as a provider are unwilling to provide for particular wants and desires of your patient, you should make that clear as early in the relationship as possible. For example, you as a provider may require urine drug screens before prescribing certain medications. You may want to make sure a primary care physician is available when the patient’s history and presentation require it. You may want family involvement for purposes of obtaining history, assuring safety, and establishing necessary support. You may feel uncomfortable with calling a phone conversation actual therapy.

I would recommend that telemedicine providers think long and hard about their ground rules for telemedicine treatment before entering into this kind of practice. Please work to anticipate, and be ready for, potential dilemmas that will arise because of the limitations of telemedicine platforms. Sometimes the platform will fail to provide a visual of your patient. Your computer, or the patient’s device, might fail in any number of ways to achieve the level of communication necessary for a proper session. A patient may present in distress and as a danger to themselves or others. And you as a provider will need to have a plan for their safety – even if you are far from your patient. A patient might compromise their own confidentiality by talking from a location that lacks privacy.

Finally, you as a provider must remember to document every pertinent fact that captures the problems and outcomes of every session. Detailed documentation helps you to keep up with subtle changes in your patient’s condition and helps your patient to have a reliable record of where this treatment has led them.

Telemedicine/teletherapy is quickly changing the landscape of the provider-patient relationship. Access to care has been exponentially increased. However, we have to be aware of the blind spots and pitfalls of this kind of care. We have to remember that what is easy or convenient might not be effective enough to address mental health concerns that, by nature, can be complicated and confusing.