Telehealth – a psychiatrist’s perspective

A smartphone with telehealth apps showing onscreen

When the pandemic hit, it became a priority to embrace telehealth to ensure continuity of care for patients, whilst keeping practitioners safe and healthy. But now, 18 months on, should telehealth be the only way forward or a welcome addition to a suite of consult alternatives?

Psychiatrist and Medical Council member, Dr Saretta Lee, believes the benefit of telehealth lies in how much patients value this is as an option (convenient, safe, flexible), as well as its ability to break down barriers to healthcare. 

‘The COVID-19 pandemic has really highlighted there are physically and mentally vulnerable people who need to be able to access healthcare remotely via telehealth. It makes a big difference, particularly for people in rural and regional Australia,’ Dr Lee says.

‘Telehealth is important because it addresses a lot of practical barriers to care – geographical, financial – but the doctor and patient need to have the opportunity to find out if it is the right alternative to the situation.’ 

Dr Lee believes telehealth should be incorporated into a broader approach to delivering health care. ‘While psychiatry is very amenable to telehealth because you don’t have to perform a physical examination in the way other specialists do, it isn’t a complete substitute for face to face sessions, even for psychiatrists,’ she said.

Cue being able to read the person, not just the words

One part of telehealth that remains a challenge for many doctors, but particularly psychiatrists, is the ability to read a patient’s subtle cues, body language and what they aren’t verbally saying. Some patients will choose to connect via video calls, but many choose audio only. This can be a result of lack of privacy at home (with many in lockdown with family or roommates), network connection quality or simply preference.

Quite often, an existing relationship with the patient, who you have already built a rapport with, can make the shift to telehealth easier. With a new patient, you are only receiving audio, sometimes with video. Combined with imperfect digital resolution or a poor connection and it can be easy to miss nuances that would be picked up in person.

Telehealth has become a much-needed tool to ensuring continuity of care, particularly or geographically isolated patients. “In psychiatry, there are some medications that can’t be prescribed unless you see and review the patient. Patients with social phobia, social anxiety, generalised anxiety, or anyone who finds it hard to leave the house – telehealth makes accessing treatment easier for them,” says Dr Lee.

“There are also differences in in terms of patient age. As you may expect, older patients are typically less comfortable with telehealth than younger patients.”

Ultimately, the ability to tailor appointment types depending on patient and practitioner preference, including the option of telehealth, allows us to provide the best patient care.

Dr Lee is hopeful that doctors and patients will be offered certainty about the future of telehealth services so patients can be continued to offered options that suit their care needs. 

How to avoid burnout and digital fatigue

While it can be tempting to maximise the number of patients you can fit in with telehealth, self-care is as important as ever. Between the additional hours of sedentary work and the drain of being trying to concentrate on a screen, Dr Lee says it is important to take short but regular breaks. “I encourage all our clinicians to take a break between appointments to stand, stretch and move to avoid stiffness. I also encourage regular breaks…and a walk outside if possible,” she says.

Is telehealth a long term option?

The pandemic has placed additional stresses on medical practitioners across the board. Beds are being reallocated to COVID patients, patients are sometimes rapidly removed to make way for a COVID patient or sometimes even discharged to other facilities. In addition, the lockdown and public health orders have seen large increases in patients seeking mental health support and treatment.

‘When telehealth was first implemented there was concern about whether it would have its own Medicare item number. Many doctors didn’t feel comfortable billing patients they weren’t having face to face consultations with. There continues to be concern that telehealth will end, and patients will not get the care they need,’ says Dr Lee.

While telehealth is a vital service, especially for those who fear leaving their homes, it is important that face to face consultation continues to be supported and that telehealth is an option in a system that allows doctors and their patients greater access to and equity around delivery of health care.

Dr Saretta Lee is a psychiatrist and member of the Medical Council. Dr Lee advocates for greater equity in the delivery services, particularly for mental health which represents the greatest burden of disease worldwide.

Ultimately, the ability to tailor appointment types depending on patient and practitioner preference, including the option of telehealth, allows us to provide the best patient care.