By PETER YELLOWLEES MD
Telepsychiatry is now an established form of mental health care. Many studies demonstrate that it meets all appropriate standards of psychiatric care and may be better than in-person consultations for certain groups of patients, such as children, adults with PTSD or anxiety disorders, or those who find it hard to leave their homes. At UC Davis all patients are now offered the option of either seeing their psychiatrist in person, online at home, or in any private setting. Many patients now choose to receive their care in a hybrid manner that can be significantly better than being seen exclusively in the clinic office for numerous reasons.
From the patient’s perspective it is more convenient, allowing them to fit their consultations into their lives, rather than having to take several hours out to travel and attend a clinic. Many patients also find this form of care to be more intimate and less threatening, with the slightly increased “distance” from the therapist allowing them to feel safer talking about stigmatized or embarrassing topics, such as trauma and abuse. We also know from numerous satisfaction studies that patients like being treated using video. In fact some groups, such as children and young adults, prefer this to conventional methods.
What has not been examined scientifically in as much detail is the impact telepsychiatry has on providers, although the latter are voting with their feet. Latest figures suggest that up to 15% of psychiatrists are now using video with their patients There are numerous advantages for psychiatrists and it is becoming clear that treating patients in a hybrid manner using telepsychiatry, as well as other technologies like messaging and secure email, may be a major response to the problem of physician burnout, making providers both more efficient and clinically effective.
So what are the advantages of telemedicine for mental health providers?
First, telemedicine consults save time for the provider in two ways. It is easier to type notes at the same time as talking to the patient using telemedicine because it is socially more appropriate to do this while maintaining eye contact via video. This can save several minutes of provider time per consult, allowing more time to be spent with patients, and/or less time completing notes after hours for the physician. Our studies show that the time saved of 5 and 7 minutes per consultation makes a massive difference to provider efficiency and reduces stress markedly over the course of a single day.
Flexibility of time and workplace is also important for providers. Working from home, even part time, and offering consults in the evening or weekends, enables a better work life balance. There are also cost savings for clinics as a decrease in patients means less administrative and rooming work, and the potential to use rooms for patients who need to be physically seen.
Improved clinical quality through teamwork is another big advantage of telepsychiatry. Many psychiatrists can work more easily with primary care physicians, who may join the consults on video, and with patients’ families, especially when the patients are seen at home. I often ask patients to give me a virtual tour of their homes, which enables me to learn more about a patient than if they were seen in the office.
Finally some psychiatrists use telepsychiatry to develop panels of patients who are in alignment with their specialty interest, perhaps working in a number of different health systems to see patients with very specific disorders in which they are expert. Other providers like the extra safety that comes with video consults, especially if dealing with potentially dangerous patients such as in correctional systems.
So how does all this connect with physician burnout, currently affecting 15-20% of all physicians, a rate that is twice as high as non-physician professionals?
There are three proven approaches that reduce burnout. The first is to increase physician resilience, and while this is important, physicians are highly resilient people. It is hard to get through medical school and residency if you are not. More important than resilience is to increase physician efficiency and support their sense of meaning of their work. Telepsychiatry and the process of hybrid care enable physicians to have more flexibility, choice, and time savings. This allows them to increasingly enjoy treating patients, about whom they learn more through the processes of improved teamwork and the use of virtual visits.
Involving the use of many varying technologies should be the new standard of care in psychiatry, and in other medical specialties, because it is good for patients and improves clinician wellbeing. If clinicians don’t look after themselves, they cannot look after their patients as effectively. Ultimately hybrid care is an obvious path for us to use to improve outcomes for all our patients.
The big question now is how best can virtual health technologies be fully integrated into routine care workflows in a patient focused manner that reduces clinician burnout and improves clinical efficiency, quality, outcomes and patient safety. Continue the conversation with me and my colleagues at ATA19, April 14-16 in New Orleans.
Peter Yellowlees is Chief Wellness Officer and Professor of Psychiatry at the University of California, Davis. He has an international reputation in telemedicine and long distance health and education delivery.