Remaining Mindful of Patient Safety When Practicing Psychiatry via Telehealth

Practicing psychiatry via telehealth offers significant advantages to clinicians, including the ability to see patients within their home setting. This access comes with additional responsibilities though, as Terry Rabinowitz, MD, professor of psychiatry and family medicine, Larner College of Medicine, University of Vermont, points out. In particular, clinicians practicing in a virtual setting should do their best to evaluate patient safety from self, others, and the environment in which they reside.

In this podcast, Dr Rabinowitz describes some of his top tips for optimizing patient treatment and experience in telepsychiatry, including steps you can take to help your patients remain safe and the importance of a clinician’s own comfort while in session.

Missed Dr Rabinowitz’s overview of “The Unofficial Rules of Telepsychiatry: Mastering Telepresence?” Find it here! For more expert insights, visit our Telehealth Excellence Forum.

Read the transcript:

Terry Rabinowitz, MD: Hi, I'm Terry Rabinowitz. I am a Psychiatrist at the University of Vermont Medical Center, and I'm a Professor of Psychiatry and Family Medicine at the Larner College of Medicine at the University of Vermont.

I think there's a couple of more tips I can give you about how to optimize the telemedicine experience.

One: make sure that the person you're visiting is safe. That's especially true for a psychiatry evaluation. My telepsychiatry experience started with nursing home residents. They're always safe because there's always a nurse with them when I interview them. But because of the COVID-19 pandemic, I've been doing virtually all of my outpatient visits via telepsychiatry.

Many of my patients struggle with feelings of despondency. Some of them are suicidal, or at least contemplating killing themselves, even if they don't have a plan. I make sure that I have the appropriate names and contact information for others who might be helpful in keeping them safe. Wherever I beam out to, I want to make sure I have at least the ability to quickly contact the local mental health crisis service, and/or police in case a patient of mine is in trouble. I might also ask for the contact information of loved ones. I will also ask all patients if there is anyone at home with them during the consultation. I might even ask if I can meet that person for a second just to let them know what I'm up to, especially if I have worries that that patient might be unsafe.

I also ask every patient if they have firearms at home. It's a little bit of a laughable question in Vermont because, as you probably know, we have a very liberal firearm ownership set of regulations/laws. Many, many people in Vermont have firearms, and many of them have no intention of giving them up, regardless of how depressed or sad or despondent they are. But some of them are willing to give them up and that's good to know. Some of them are willing to get them locked up, and have someone else have the key, and that's good. If you don't ask, you won't know. So it's a good thing to do.

The other thing, a tip that I would give, is make sure that you're comfortable. Where you're sitting, what you're doing, check everything before you open the session. For instance, right now I have a special video conference light that sits on top of my laptop computer. I can adjust the brightness of the light, I can adjust the color temperature of the light, so I make sure that I can be seen as clearly as possible before the visit ever begins. I also make sure I'm sitting in a comfortable chair, that I've already hydrated myself, used the men's room, et cetera. So, that visit is as close to the in-person experience as it can possibly be.

Terry Rabinowitz, MD, is a professor in the Departments of Psychiatry and Family Medicine at the Larner College of Medicine, University of Vermont, and medical director of the Psychiatry Consultation Service at the University of Vermont Medical Center. He has been a member of the Academy of Consultation-Liaison Psychiatry (ACLP) since 1993. He is the founding Chair of the ACLP Telepsychiatry SIG. He is a member of the Board of ACLP and Chairs the ACLP Membership Committee. He serves on the Editorial Board of JACLP. He has been the Principal Investigator or Co-Investigator on government-funded projects in both the US and Canada, including an Office for the Advancement of Telehealth (OAT)-funded project to develop and implement a regional telehealth resource center (the Northeast Telehealth Resource Center, NETRC) whose mission is to help fledgling telemedicine programs develop into independent telemedicine services.  His research interests include design, implementation, and testing of psychiatric assessment instruments; psychiatric assessment and treatment of persons with cancer; ECT and the somatic therapies; and development and evaluation of telemedicine services.

Dr Rabinowitz received his MD degree from the Case Western Reserve University College of Medicine and completed Psychiatry residency training at McLean Hospital and fellowship training in Consultation-Liaison Psychiatry at Massachusetts General Hospital. He has been at the University of Vermont Medical Center and the Medical College since 1996.