How to Establish Better Virtual Patient Rapport

“For the longest time before the COVID-19 pandemic, a lot of people thought telepsychiatry was its own separate way of practicing psychiatry…But it's really not different. Telepsychiatry is still practicing psychiatry, just via a different modality,” observes Lucia Cheng, MD.

Psych Congress Network connected with Dr Cheng on-site at the 2024 Psych Congress Elevate meeting in Las Vegas, Nevada, to discuss some key clinical pearls that mental clinicians practicing in a telehealth setting can implement to establish a stronger connection with their patients virtually. In this Q&A, Dr Cheng emphasizes the importance of maintaining virtual “eye contact” as well as clarifies the idea that telepsychiatry is its own specialty within psychiatry.

For more expert insights for your virtual practice, visit the Telehealth Excellence Forum right here on Psych Congress Network.

Save the date for the 2025 Psych Congress Elevate meeting: May 28-31, 2025, in Las Vegas, Nevada.

Brionna Mendoza, Associate Digital Editor, Psych Congress Network: What are some of the most common challenges that clinicians can anticipate in a telehealth psychiatry practice, and what are a couple of strategies that they can deploy to help navigate these challenges?

Lucia Cheng, MD: A very common challenge with practicing psychiatry is patient comfort and patient rapport because obviously you don't have the patient in the room with you. There is more difficult eye contact, you can't have physical cues, a lot of time you're only seeing patients from the chest up. So, it's very important for the clinician to really set the tone in the telepsych visits. The more comfortable the clinician is, the more comfortable the patient is. The clinician really is important in setting that tone for the patient.

There are certain strategies that a clinician can use, such as making sure that you are facing the camera properly, and maintaining a good eye line between you and the camera. That's actually an aspect where a lot of clinicians get hung up because the way that the computer system is set up, the camera is actually offset from where the patient's image is on the screen. While the clinician feels like, “I'm looking at the patient and I'm paying attention to the patient cues,” they're not actually looking at the camera. The camera is picking up the side of the clinician's face, and the patient ends up feeling like, “The clinician isn't paying attention to me because they never look at me.” In that aspect, the clinician really needs to pay attention to maintaining good eye line with the camera.

To help, most telehealth platforms will have that self-view image at the corner that you move around. A lot of clinicians are very uncomfortable looking at themselves, so they just get rid of it, but that's actually a very bad idea because then you have no idea what the patient sees. Maintaining that image will at least give you some idea of, how do I look for this patient? Is the lighting too bright? Is it too dark? Am merging with the background so it looks like a floating head? Am I making proper eye line with the patient?

Take that step so that the patient feels like you're actually looking at them, which goes a very long way in establishing that patient rapport.

Mendoza, Psych Congress Network: Which misconceptions about telepsychiatry would you like to clarify for our audience?

Dr Cheng: Telepsychiatry really is fairly new to the mainstream. It has actually been done for decades now, it was just really only done in certain rare cases by research institutions, for example. For the longest time before the COVID-19 pandemic, a lot of people thought telepsychiatry was its own separate way of practicing psychiatry. A lot of clinicians would describe, “well, I saw a patient and I practice psychiatry,” or “I practice telepsychiatry.” But it's really not different. Telepsychiatry is still practicing psychiatry, just doing it via a different modality. The standards of care are still the same. Your expectations for clinical judgment are still the same. It's just that the people involved are not necessarily in the same room together. But I think that for a lot of patients, as well as clinicians, they still feel like it's a different way of practicing psychiatry, and it's really not.

Lucia Cheng, MD, is a board-certified psychiatrist specializing in Reproductive Psychiatry. Dr. Cheng is also board-certified in Lifestyle Medicine. She attended medical school at Medical College of Wisconsin and completed psychiatry residency at Loma Linda University (LLU) Medical Center. She is currently an adjunct assistant professor at LLUH Psychiatry Residency and enjoys teaching the psychiatry residents there. Dr Cheng currently owns her multistate telepsychiatry private practice Phoenix Progressive Psychiatric Services. She volunteers as an expert perinatal psychiatry consultant for the Postpartum Support International (PSI) Prescriber Consult Line and currently serves on the International Society of Reproductive Psychiatry (ISRP) board of directors. Dr Cheng is also an avid video gamer and specializes in providing mental health care to other video gamers.