In-person vs telepsychiatry

[thepoopologist]

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Poll. And why?

 

[NickNaylor]

Not a fan of telepsychiatry - I feel like something is lost in the encounter. I think it's better than nothing, but it would take a lot for me to willingly do telepsychiatry work.

 

[dl2dp2]

I recently started doing hardcore psychodynamic psychotherapy with telepsychiatry (due to COVID). It works reasonably if both ends have high-resolution video. But yes, a decent amount is lost. A lot of transference is in microexpressions, body language, etc.

Pharmacology is fine over video (with some caveats i.e. depot, urine testing, blood pressure, EPS, etc). I think behaviorally oriented therapy is probably okay over video, and I have done it before with a reasonable amount of efficacy.

 

[NickNaylor]

I should add that I also don't prefer it as a patient. I've been doing phone sessions for my analysis over the couple of weeks... it's a necessarily evil but I much prefer the in-person sessions. Though with being on the phone - assuming you have headphones - it's almost like lying on the couch.

 

[tr]

I'm so glad it is available as an option but it's of course inferior to working in person. It works better for psychopharm than for therapy. I can't get a full MSE (eye contact, posture, etc) and it would be difficult to do an AIMS and impossible to check for cogwheeling rigidity. But those are not crucial to most of my patient encounters.

I do structured CBT and it's super inconvenient not to be able to see and write on the same form at the same time. I'm sure there's a workaround with Google docs though, which I will have to figure out if this goes on much longer.

I dropped my therapist rating form altogether because I don't have a fillable version. Right now I just have a couple of patients I've been working with for a while, we have a good alliance and a history of positive rating forms, so I don't think it's done too much harm yet. But I don't see how I could work effectively with a newer or more interpersonally difficult patient without that form.

 

[clausewitz2]

I'm so glad it is available as an option but it's of course inferior to working in person. It works better for psychopharm than for therapy. I can't get a full MSE (eye contact, posture, etc) and it would be difficult to do an AIMS and impossible to check for cogwheeling rigidity. But those are not crucial to most of my patient encounters.

I do structured CBT and it's super inconvenient not to be able to see and write on the same form at the same time. I'm sure there's a workaround with Google docs though, which I will have to figure out if this goes on much longer.

I dropped my therapist rating form altogether because I don't have a fillable version. Right now I just have a couple of patients I've been working with for a while, we have a good alliance and a history of positive rating forms, so I don't think it's done too much harm yet. But I don't see how I could work effectively with a newer or more interpersonally difficult patient without that form.

I would kill for even just a digital whiteboard incorporated into doxy.me

 

[hebel]

If it's worth it to pay extra, zoom and I believe WebEx as well have virtual whiteboard features.

 

[clausewitz2]

If it's worth it to pay extra, zoom and I believe WebEx as well have virtual whiteboard features.

Zoom is basically malware, nobody should be using it for telehealth for any reason

 

[hamstergang]

I do like telehealth because:
-it's far superior to the phone and we can't have people physically coming in now
-I am starting many more sessions on time because I'm not waiting for people to somehow be late every single time they drive to the same building (though 1 patient so far was in the car at the time we were supposed to start a telehealth visit)
-no-shows seem reduced, but I don't know if that's due to telehealth or the pandemic

However, I agree with the others that we lose quite a bit from not being in person. There are vitals to check, AIMS to do, and if something's reported on ROS I may want to check it out. In general, non-verbal communication is also important (expressing and receiving) but hard to get through video. But worst of all so far was when a patient started crying and put his face off screen. I had no idea what to do/how to respond.

 

[Sushirolls]

doxy.me I believe has a screen share feature.

 

[Bartelby]

I would kill for even just a digital whiteboard incorporated into doxy.me

Why is that? We have used it for virtual team meetings and that has gone well. No patient interactions via Zoom so far though.

 

[clausewitz2]

Why is that? We have used it for virtual team meetings and that has gone well. No patient interactions via Zoom so far though.

It is completely and totally insecure and is a really excellent route into controlling someone else's webcam if you know what you're doing. A lot of known vulnerabilities that are not getting fixed.

 

[Sushirolls]

I'm starting to have a string of patients lighting up their cigarettes during the Telepsych appointments, or walking outside to then smoke.

 

[hebel]

I'm starting to have a string of patients lighting up their cigarettes during the Telepsych appointments, or walking outside to then smoke.

Reminds me of the old "Gloria" psychotherapy videos...both the patient and the doctor were lighting up haha.