In today’s COVID world, many mental health patients are finding themselves “forced” into seeing their doctors online rather than in person. But how effective is telehealth? What are the benefits and disadvantages?
Today’s guest is psychiatrist Dr. Frank Chen, who thoroughly explains the whole new world of telemedicine and why it doesn’t have to be scary. In fact, many patients, including Gabe, have found it to be quite convenient!
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Computer Generated Transcript for ‘Frank Chen – Is Telehealth Effective?’ Episode
Editor’s Note: Please be mindful that this transcript has been computer generated and therefore may contain inaccuracies and grammar errors. Thank you.
Announcer: You’re listening to the Psych Central Podcast, where guest experts in the field of psychology and mental health share thought-provoking information using plain, everyday language. Here’s your host, Gabe Howard.
Gabe Howard: Hello, everyone, and welcome to this week’s episode of The Psych Central Podcast, I’m your host, Gabe Howard, and calling into the show today, we have Dr. Frank Chen. Dr. Chen is a practicing psychiatrist in Houston, Texas, who specializes in adult psychiatry. Dr. Chen is the chief medical officer at Houston Behavioral Health Care Hospital and Houston Adult Psychiatry. Dr. Chen, welcome to the show.
Dr. Frank Chen: Hey, Gabe, thanks for inviting me to your show during these strange times.
Gabe Howard: Well, we’re very glad to have you and listen, we’re going to talk about telehealth. Now, telehealth has been around for several years now, but because of the global pandemic and resulting quarantines and social distancing, we’re hearing so much more about it. It’s even become a popular topic in the mainstream media. Now, this podcast has been sponsored for several years by BetterHelp.com, which is online therapy, which, of course, is telehealth. So all this to say is that our listeners are quite familiar with the concept. But this is the first opportunity we’ve had to discuss this with a provider, with a medical doctor about the use of telehealth, for example, to prescribe medication or to diagnose. Is there a difference between telehealth as used for therapy and the use of telehealth for more complicated or serious issues?
Dr. Frank Chen: Certainly, we all had to adapt to a different way of getting medical care during this pandemic. As you guys all know, the doctor’s waiting room may be a breeding ground for the spread of various different contagious diseases. And so we don’t want to exacerbate the situation. And various different regulatory agencies and third-party payers have made the transition into telehealth much more available starting March of 2020. We had to really accelerate the progression into almost complete transformation of patient care to telehealth. This has been difficult for both patients and also clinicians. We all experience technical difficulties associated with engaging in the telehealth modality. But as we become much more familiar with this modality, it seems that there’s been much more positive approval of treatment through a telehealth platform. Most of our patients were very hesitant about engaging with the clinician in electronic fashion. They’re used to the face to face and especially in psychiatry, where there is an appearance of privacy in the confines of the four walls. So, it took some time for adaptation. Some of our newer patients who had made appointments prior to the pandemic canceled appointments because they wanted to wait and see someone in person.
Dr. Frank Chen: However, as time went on, more and more patients are adapting to this platform. More and more clinicians are getting familiar with this platform. Now, your question, Gabe, about whether or not it is just as advantageous getting treatment via the telehealth platform for medication purposes. And the answer is yes. In a recent Alkermes Harris poll, it appears that at the time, one in four patients have started using the telehealth platform. And 62% of the tele psychiatry users surveyed say that they would not be able to get the care they need without the telehealth service. And 67% agree that the telehealth service that they’ve been using helped them stick to their treatment regimen. We started getting into the telehealth platform out of necessity. But I think that there’s broad adaptation at this point that people are starting to feel that this is the norm rather than the exception.
Gabe Howard: My entire perspective of telehealth is from the patient perspective. I’ve never been a doctor, I’ve never been a clinician, I’ve never seen patients. So, it’s interesting to me something that you said there, which is the practitioners are having trouble adjusting. Can you talk about that a little bit? Because we just assume that all doctors were like, yeah, telehealth. We don’t have a problem with this. This is easy. But it sounds like you’re saying that there were some growing pains on their side as well. And I think that will make patients feel a lot better.
Dr. Frank Chen: If you look at the history of telehealth, it’s evident that there were some necessary infrastructure that would allow this platform to occur. So telehealth has probably been played around with for the last three decades. And initially you basically needed equipment that’s tens of thousands of dollars. And because of regulatory requirements and also third-party requirements, these health platforms were isolated to rural areas and maybe the prison system. And it was during the last decade when there’s much more bandwidth and also the portability of technology that we started seeing telehealth being used on a retail level. I got to tell you, I had been using telehealth as part of the option for our patients, my office is the suburban area in Houston, and we generally see working clientele. And even though there’s a convenience factor where you don’t have to drive into the office, it seems that most of our clients were very much entrenched in coming in seeing us in the confines of our office because they do feel secure in there. Especially for mental health treatment. And it’s not until this pandemic that there was global adaptation to this platform. It seems that our patients are starting to ask for telehealth now rather than wanting to come into the office. And it is because of the convenience factor. We seem to experience much more of a relaxed environment with telehealth patients in their homes. And we actually are making home visits. We get to see a slice of their everyday life. We are able to capture clientele that we normally may not be able to capture. So, for instance, I have a patient with schizophrenia who refused to take medications and she would end up in the hospital because of exacerbation.
Dr. Frank Chen: And since the advent of technology and telehealth, I’ve been able to do home visits with her and was able to see that she has a lovely family who’s taking care of her, that her house is clean and she was engaging. The patient would end up in the hospital once or twice a year because of noncompliance with medications, but because I was able to beam myself into her house, I was able to treat her. So, it really opens up availability of treatment for patients. Because some of the regulations have been relaxed by the federal entities and state entities that govern the practice of medicine. We are now able to prescribe medications and establish new patient appointments through telehealth. And this has really been a godsend for a lot of patients who are unable to come into the office or who have difficulties navigating that office visit. Patients are showing up at nearly 100% show rate because it’s pretty convenient. They don’t have to drive in and we are able to capture a slice of their life. Now, there’s some disadvantages. You may be sharing a room with family members or you may have roommates and you don’t necessarily have the privacy. Sometimes when you do these telehealth appointments from a clinician’s perspective, we’ve seen weird places where people decide to engage in telehealth treatment. I’ve done treatments with patients while they’re running. I’ve done treatments with patients while they’re engaging in dinner. So it really is a challenge sometimes getting them to seriously participate in the subject at hand from a physician’s perspective. But we’re able to do everything that we do in office with this platform.
Gabe Howard: Now, you’re a medical doctor, if somebody comes to you and says, I feel like I have a mental health condition, are you able to meet with them and give them a diagnosis without ever sharing space with them just over video chat, Skype or Zoom?
Dr. Frank Chen: Absolutely. Gabe, you got to remember that psychiatry is a is an area where accurate history taking is what we need. We need information on patients’ background. We need information on their symptoms. And those are all expressed vocally. Now, sometimes, you know, it does help to see the patients and see their behavior, but for the most part, to arrive at an accurate diagnosis, it’s history taking. Even though we’re not in the same space at the same time, we can get some minimal information visually through tele psychiatry. And as long as we’re able to accurately get to the relevant information that assists in making an accurate diagnosis, we don’t really have to be in the same physical space. I actually think that sometimes it’s more necessary for therapy. When you’re doing therapy, you may actually lose some information when the patient is not in the room. For instance, sometimes the therapist may purposely introduce the awkward silence and see what happens to the patient. It is less likely that the patient will be uncomfortable on a virtual platform because there’s a lack of personalization almost. They’re on camera. From my perspective, it seems that as long as I can get data, whether from the patient, whether it’s from the family, I’m able to come up with a relatively accurate diagnosis.
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Gabe Howard: And we’re back discussing telehealth with Dr. Frank Chen.
Gabe Howard: I think about before the pandemic, and people would say to me, Gabe, what do you think about telehealth? I mean, telehealth is going to be a thing. They’re doing everything on the Internet. What do you think about seeing a doctor online? And I didn’t like it. Gabe Howard was not a fan of telehealth. I understood it for therapy. People are busy. Depending on the type of therapy you need, where you’re at, etc., perhaps this could be a good thing. And of course, I always left room for however people find recovery is their own business and it’s not my business. But personally, I was not a fan. And then, of course, the pandemic happened. I needed to see my psychiatrist. The only way that I could see my psychiatrist was through telehealth. I made the appointment and I thought, hey, I need a med refill. And she’s unwilling to do it unless I do this telehealth thing. So, I jump through the hoop out of complete necessity. I want to be very clear. I was forced. I was forced to do it. It was incredible. I loved it. I got to wait in my own home. I didn’t have to fight traffic. It was perfect. She talked to me for twenty minutes. I got all my medications refilled. I am now complete 180. I am a complete fan. Are you finding the people that are quote unquote forced into this are having similar results?
Dr. Frank Chen: So, Gabe, you’ll be happy to know that you’re probably one of the normal people around with that experience. That is the hallmark of what I have seen as we offer telehealth through the last five to 10 years in my office. No one wanted to do it. And again, when you are someone in the rural community and you have no providers around and the only place that you can get care is at a community mental health center and through telehealth with a doctor in a metropolitan area, you have to do it. But there was not a whole lot of adaptation. Again, people feel that there is a connection with the clinician when you go in there and see them and they’re willing to spend an hour driving to a psychiatrist, an hour waiting in the waiting room, and then another hour going back home. But since we were all forced into this, the concepts have changed. The initial reaction for our patients is that they don’t want to do it. Some of the new clients canceled because they wanted to test out the clinician in person. Some of them canceled the appointments and say, we’ll wait until this pandemic is over.
Dr. Frank Chen: Obviously, it’s not over yet and they have to get their medications. And so we’re all forced at this point to engage in this platform, whether you’re in health care, whether you’re in business. And so the more that we engage with patients in this platform, the more satisfied the patients are with the convenience of this platform. People are actually calling in saying, hey, are you still doing telehealth? Are you still providing care over the Internet? Because I don’t have time to drive in there. There’s a complete shift in the concept of telehealth. They’re no longer thinking about the uncomfortableness of talking virtually. They’re requesting it because it is much more convenient. And I got to tell you, Gabe, this is opened up treatment for a lot of my patients.
Gabe Howard: I’m very fortunate, I live in central Ohio, which is a very big metropolitan area. I have a lot of options. I can be very picky. I can. I have very niche options that aren’t available in, say, the small town that I graduated high school in. And I think about that small town. I think there was 3,000 to 4,000 people there. We didn’t even have a hospital. We didn’t have a movie theater. We didn’t have a bowling alley. It was a very small town. And as such, everybody knew everybody. So, if I had a very specific problem or I wanted to see a very niche therapist, one they might not be available, but two, even if they were available, everybody would see me walk in the door and they’d be like, oh, Gabe is going to that, you know, niche therapist. And now everybody would know that I had this issue or potentially had this problem. The gossip mill would start. This is resolved via telehealth, is it not? You can find that niche therapist anywhere in America and you have more of an expectation of privacy because you never actually leave your own home.
Dr. Frank Chen: I think that at this point, your therapist is an in-home therapist, your psychiatrist is an in-home psychiatrist, it’s no longer a chore to drive two hours away if you’re living in a rural town to see a psychiatrist who can provide you with the care. It is as convenient as filling out a form online to request an appointment. The broader adaptation of telehealth has also made clinicians much more comfortable about accepting patients who live one hundred miles away. People around the country can all receive good care from anyone practicing within their jurisdiction. And this is a huge transformational moment in our industry. People are no longer limited to those options within their confines. They can seek out appropriate help in any distant locale as conveniently as driving down the street. This is really a godsend for a lot of patients who are stuck in terms of not being able to get adequate mental health care, especially in those rural areas.
Gabe Howard: One of the criticisms that I hear is that you have to be tech savvy, you have to have a computer, you have to have a lot of bandwidth, you have to understand how computers work. And then people start saying things like the older generation doesn’t know how to do it or rural areas don’t have good Internet or what if you don’t own a computer? Are those just excuses? Is this actually a reality for people or are you finding that this is really relatively simple? And, well sure, there is somebody that may have a problem with it, by and large, this is a very simplistic process that people are embracing and aren’t struggling with at all.
Dr. Frank Chen: I think over the last six months, as we are thrust into this platform, companies are adapting to the needs of both the clinicians and the patients. They’re making this process easier and easier. Your telehealth session can be started by a clinician with a link to your text and you press on the link and you’re connected. In the past, there’s certainly some challenges. Some of the companies that provide this tele psychiatry platform may make you sign up for an account. You may have to sign into a waiting room. You may have to wait around not knowing your status. But over the last six months the companies that provide these platforms are working with clinicians as well as patients to refine the process so that it can be simplified for a lot of patients, even elderly patients. We do have challenges in terms of bandwidth, but we can always reconnect. After getting used to a platform, we know some of the typical difficulties that we may encounter. For instance, sometimes when you have a call coming in, as you’re doing your telehealth session, your telehealth session may be dropped. And we all know that now and so we can reengage with the patients. It is certainly a process of adaptation, but I think we’re all, as a society, getting used to having our health care delivered in this fashion.
Gabe Howard: Dr. Chen, how has the industry responded to this? Anything coming from insurance companies or payer sources that makes telehealth either better or worse?
Dr. Frank Chen: Gabe, I think a lot of our third-party payers, Blue Cross Blue Shield, Cigna, they understand the need for patients to stay out of waiting rooms during the pandemic. They are much more receptive about the telehealth platform. And as a matter of fact, there’s another aspect of this telehealth that’s being introduced. The Centers for Medicare & Medicaid Services have relaxed a lot of rules associated with face-to-face visits. So I work at a hospital called Houston Behavioral Health Care Hospital in Houston. As we started preparing for the pandemic, we also started setting up the infrastructure for telehealth in an inpatient environment. This is to make sure that the doctors do not end up spreading airborne viruses to their patients as they’re making rounds. This is certainly a transformation in the way in which we think about getting care in an inpatient environment. It’s been somewhat successful. You certainly deal with a much higher acuity of patients who are manic patients who are psychotic in the setting. But we are able to capture most of their behavior with collaboration and provide adequate care for our patients without that face-to-face visit.
Gabe Howard: From the perspective of a doctor, from the perspective of a provider, is there anything that you want patients to know that you have learned being on the provider side of telehealth?
Dr. Frank Chen: I’ve got to tell the audience that don’t be afraid to engage in this platform. You’re going to adapt to this just like you adapt to everything else. And it is so much more convenient for my patients to get care wherever they’re located. It is a simple process of getting the medication electronically transferred to their local pharmacy. It is hassle free in terms of making appointments with some of these platforms. And so I’d like everyone to try to embrace this platform because I do believe that this is going to continue after the pandemic.
Gabe Howard: So it sounds like you think that telehealth is just going to get bigger and bigger and that you like that idea, you don’t see that as a step backwards. That is a big step forward.
Dr. Frank Chen: Absolutely, I think that clinicians are adapting to this platform. They can work anywhere they want, they can transmit prescriptions to any pharmacy. It’s actually making the work flow a lot easier. You have a lot of clinicians who are part time clinicians and they’re willing to come online now because it’s very easy for them to arrange their schedules. You have much more availability of care with this platform. And I think that people will accept this platform in psychiatry and this will continue. We lose some data in terms of not having the face to face engagement. It’s difficult to see anxiety in some patients when they’re just staring at the camera, but they can tell you. Despite losing some data, we also gain a lot of information. We can see the patients in their natural environment. We can see whether or not they’re truly getting taken care of. We can visualize aspects of their life that may be worrisome because we’re making that home visit. And so there’s tremendous advantages to continuing with this platform. And I think that our future will be a mix of face-to-face, but also a good deal of telehealth included in the care of psychiatric patients.
Gabe Howard: Dr. Chen, thank you so much for being on the show, we really appreciated having you.
Dr. Frank Chen: Thank you, Gabe.
Gabe Howard: Thank you to all of our listeners for tuning in this week to The Psych Central Podcast. Wherever you downloaded it, please subscribe. Also, rate us, rank us, use your words and tell people why they should listen too. Also share us on social media. We love that. Speaking of social media, we have a secret Facebook group that I’d like to invite you to join. Here’s a quick link to find it: PsychCentral.com/FBShow. And remember, you can get one week of free, convenient, affordable, private online counseling anytime, anywhere simply by visiting BetterHelp.com/PsychCentral. We’ll see everybody next week,
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