Tips for Transitioning to Telepsychiatry

Drew Ramsey, MD


March 26, 2020

This transcript has been edited for clarity.

COVID-19 is changing so much about how we practice and how we interact. It's affecting all fields of medicine, and for sure it's affecting psychiatry.

Hi, everyone. I'm Dr Drew Ramsey and I wanted to share some of my experiences upgrading or changing my practice to do more telepsychiatry, as I suspect that so many of you are now engaging with this platform for the first time.

I started doing telepsychiatry about 10 years ago, as I had a number of patients in New York who were traveling to other states or countries, where I would need to see them occasionally. About 3 years ago, due to some health events in my family, I had to split my time between Indiana and New York City, where my practice is.

I was really concerned that that would be the end of my New York City practice, but in fact, about half of my practice is telepsychiatry now. It's a modality I've really come to enjoy.

There's the idea that telepsychiatry is not as good as in-person visits. Now that this is the time to explore telepsychiatry more, I think we should challenge that idea. There are many ways that telepsychiatry is actually much more effective than in-person visits. The data suggest that it's equal.

In situations like this, I'm really thankful. I've seen almost all of my patients in my New York practice while I'm here in Indiana self-quarantined.

Let me give you a few of my tips. There are many pieces of advice for sure. Check out all of the great writing by Steven Chan, a psychiatrist who created a telepsychiatry tool kit that will give you some of the basics. For those of you who are in private practice and aren't HIPAA compliant, you're going to face a platform issue.

When I started using telepsychiatry—I'm in private practice and I really feel a desire to serve my patients—I asked them what platform they prefer. That's not exactly what everyone is going to tell you to do. I'm not a HIPAA-compliant entity and I do my best to preserve my patients' confidentiality.

In terms of platforms, there are all of the HIPAA-compliant platforms, some of which are very cost-effective. There's FaceTime, which the US Department of Veterans Affairs uses. I feel that if it's good enough for them, it's probably good enough for me. That's the major platform I use, but I have some patients who prefer Zoom and others prefer Skype.

I tell them the warnings, I document that in the chart, and then I try to have a good connection with them. That's really important with telepsychiatry. You can see that this is where I do my work. I try to have some place that isn't very distracting. That's really like how I practice in my office. I don't have many paintings, but make it kind of fit your persona as a practitioner.

Be aware that you can do a lot with telepsychiatry. You can move how close you are just a little bit and subtly change the intensity of your interpretation. One of the great things about telepsychiatry is that I can take my office with me everywhere. You might not think that's ideal, but I'm a mobile person and I like the fact that occasionally, instead of a bad phone session, I can find a quiet place and have a good session with the patient where we can see each other.

Other important things for me include noise-canceling headphones. This is another way that telepsychiatry has a little advantage. All I'm hearing is the patient's voice and it really creates a very focused, still, intense experience. Again, not the same as in person, but modified, and as one of my patients said, it's a great way to augment an in-person therapy.

Many of my patients, because I have asked them, argue that therapy with some augmentation—telepsychiatry—has been better because it's been more flexible. I've been able to see them when they're ill, for example, and they can't come to the office, or when there's an emergency. It has really allowed a thread of therapy to continue for them.

There are some specifics you should know about when using modifiers like GT and 95. Certainly, if you're in a larger organization, there will be many policies about this in place, so you should become familiar with those.

I mainly wanted you to hear my encouragement as a psychiatrist to start using telepsychiatry, and to take on that notion that it's not as good as in person. We all know that there's something to that, but as one of my patients said, it's like 67%—about two thirds. And that's about everything in psychiatry, right?

I'm Dr Drew Ramsey. I'd love to hear your comments below on how you are using telepsychiatry, especially during COVID-19, and how you're enhancing or adapting how you provide services to your patients.

Mainly, all of us here at Medscape want to offer encouragement to keep doing what you do best, which is taking care of patients. Take good care of them.

Dr Drew Ramsey is a private-practice psychiatrist in New York City and an assistant clinical professor of psychiatry in the Columbia University Department of Psychiatry. He splits his time between New York and his family farm in Indiana. 

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