Which Psychiatric Disease States Especially Benefit From Telehealth Practice?

There are no exact substitutes for conducting mental health care in person, but as Terry Rabinowitz, MD, professor of psychiatry and family medicine, Larner College of Medicine, University of Vermont, points out, there are some patients with disease states that may prefer the flexibility and distance provided through telehealth.

In this podcast, Dr Rabinowitz provides an overview of his experience providing psychiatry consultation services via telehealth as well as which conditions he feels “a fair amount is gained” from telehealth care.

Don’t miss out on these other clinical pearls from Dr Rabinowitz:

>>The Unofficial Rules of Telepsychiatry Practice: Mastering Telepresence

>>Remaining Mindful of Patient Safety When Practicing Psychiatry via Telehealth

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've been at the University of Vermont since 1996, I came to the university to become the medical director of the psychiatry consultation service.  

Brionna Mendoza, Associate Digital Editor, Psych Congress Network: Great, thank you. Okay, let's dive in. Could you tell us about some of the disease states that you've treated via telehealth, and your experience treating those patients in a remote setting?

Dr Rabinowitz: I started a psychiatry consultation service here back in 2002. And when I was asked to design and implement that service, I wasn't sure what patient population would best be served. But I had experience working with older patients, and I thought, "Well, they're often an underserved population." And so I chose to perform psychiatry consultations for nursing home residents, and I've been providing those consultations since 2002 without a stop, or break to the present time. I don't see a lot of patients that way, but I do see them regularly, and have been consulting to the same nursing home in upstate New York for that time.

The different conditions that I've seen and treated since then, have really spanned the spectrum of psychiatric conditions. I'll give you a couple or more than a couple of conditions that I've treated starting with dementia, not only of the Alzheimer disease type, but also lewy body dementia, vascular dementia, multifactorial dementia. But in addition to dementia, I've treated major depressive disorder, generalized anxiety disorder, bipolar disorder, schizoaffective disorder, mania, hypomania, delirium, and many patients with co-occurring personality disorders as well.

Mendoza: In treating these patients, as someone who has worked with these patients both in person and remotely. What are some of the differences in the experience that you notice?

Dr Rabinowitz: I am a big advocate for telemedicine, but I will tell you that there's nothing that compares with a person to person encounter. If someone said, what's your preference? I'd say most often, I prefer face-to-face in-person encounters, but I've learned, and seen over the years that little is lost, and sometimes a fair amount is gained from using telepsychiatry rather than in-person encounters.

Some examples of the advantages of telepsychiatry include the ability to see a person in their own environment. This has been especially the case during the COVID-19 pandemic, where rather than having patients come to my office, I [inaudible 00:06:33]. So I get to see where they live, how they live, who else is around them, who else may be distractions to them. Oftentimes I get to speak with their partner, or spouse, or brother, or sister, or parents. So those extra things have really been helpful to me, and help to really round out a patient, if you will, give me more useful data.

I've also found that the telemedicine approach actually works better for some patient types. For example, patients on the autism spectrum, where those with severe mental illnesses like schizophrenia, often prefer having a bit of distance between them and others. So, when I use my telepsychiatry approach, oftentimes those patients seem more at ease because they're not in the same room with me, and they have the comfort, or the security of being in their own environment. In addition, they can turn their gaze away from me if they wish, they can move the camera away from me. And so that helps them to avoid direct eye contact as well as   of course, the direct person to person contact that might happen without the use of a video conference approach.

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.