In today’s new normal, the broader acceptance of telehealth and telemedicine has become essential.
There seems like there’s an endless onslaught of bad news.
Negative headlines, the overwhelming stress of working studying from home mental health care finds itself taking a higher priority than ever before.
For more and more people may find that the concept of the traditional therapy couch is going the way of the dodo.
And doctors and psychiatrists are increasingly learning and developing new ways to work with patients over the internet in this new office lis kind of environment, we have to ask.
Joining us today we have Dr. Peter Yellowlees of UC Davis.
You have literally written the book On how to practice telemedicine, tell us a little bit more about what you do and your expertise and how you came by it.
So I’m a professor of psychiatry at UC Davis in Sacramento.
I’m also the chief wellness officer for our health system.
So I’m particularly interested in the The health of health care workers I’ve been interested in telemedicine and mental health in particular for about 30 years now, and I was the only psychiatrist working in Central Australia.
My patch of ground was literally the same landmass as California.
But there were only 30,000 people living there.
And so back in the early 1990s I actually got a large grant and installed Video conferencing systems and started seeing patients at a distance using video.
And I’ve just just been doing it ever since.
So we’ve done over many years a lot of research into the effectiveness of online therapy and assessments.
And then come covid suddenly everybody realizes that they’ve really got to use this stuff because they’re trapped at home they feel unsafe and and certainly the use of video conferencing and equivalent technologies has increased, literally hundreds of men many hundred fold over the last few months.
So let me ask you in this time so it’s increased many hundred fold probably some people are very happy about that change and if they feel more comfortable in their own homes having difficult conversations, there are probably some people who feel less happy about and some of them are probably practitioners.
What have you Found in your early work to help those practitioners approach telehealth in a way that they might not have felt comfortable doing before.
I think that’s a really crucial difference.
The Difference in attitudes between patients and practitioners.
Patients have essentially always loved this.
They’ve always found it a very easy way of working.
It’s been much more convenient and gives them easier access to their providers.
If you’re absolutely right, it’s the providers, the therapists, psychologists and psychiatrists who found it more difficult.
And in reality, it’s not surprising it’s because they’re the ones who have to make bigger changes.
To actually start working in a slightly different way.
But now that everybody has to make these changes, actually most people have found is not nearly as difficult as that and that it’s actually in some respects much more convenient and easier.
Working online or perhaps also seeing patients in a hybrid we’ve seen them you know in person as well sometimes.
And, and so we we’ve started looking much more at the advantages of using online video.
Compared with the in person world, and if you look at the advantages, essentially what happens is that we’re doing a whole lot of home visits.
We’re seeing people in their homes in their own environments.
We can see what pictures they’ve got on the wall.
You can see behind me a little bit of time keen on sailing, and it’s actually very good.
It actually improves the relationships you have with patients to be able to see them in a more egalitarian manner, because inevitably going to somebody’s clinic is a little bit intimidating for many people, as well as being inconvenient.
What are the special aspects of video That are different for for clinicians.
Are there different cues that that doctors get?
Are there different kind of aspects of that that relationship that are changed by technology?
And just give us a little bit of detail about that.
What what is it that changes are what changes for a doctor and what they’re looking at I think there’s two big changes.
The first is just how you manage the interview.
In that you have, you have less physical signs that you can use to sort of point out to people that the interview time is nearly up.
For instance, so you actually have to say look, we’ve only got five minutes left or what you end up doing in reality is actually having a conversation but summarizing more frequently with patients, then you perhaps do an in person well night and that’s a good thing.
Because patients get the chance to maybe correct you if you’re not sure what you’re hearing.
So I think it’s very good for active listening skills from a provider perspective.
The other thing that is fascinating is that both patients and providers tend to be a little bit less inhibited on video than they are In the real world in person, and I’m sure you’re like me You’ve personally reply to all button on email a few times when you haven’t really wanted to and you regret it afterwards at your leisure.
And, and that there’s actually a lot of scientific evidence to show that actually people.
People are both more truthful online, and they tend to also speak with ease about difficult topics.
So in my world that might be, say a female who’s been raped, they might find it actually a lot easier to talk to me about that on video.
They would see me in person and might go into a lot more detail and find it less threatening.>> Yeah, that’s interesting because, you know, there might be this instinct for most people carry Actually Thinking about telepsychiatry over camera that people might be really worried about privacy issues, but it seems like what you’re saying is that they’re less worried about privacy issues with with a sort of a, the wall of the internet between you.>> That’s exactly right.
There is no doubt there the extra the extra physical and psychological distance that you get In an interview like we’re doing now, actually makes it easier to talk to people.
It’s less embarrassing potentially.
And, you know, I discovered that actually, very early on literally with the first patient that I saw, who was an Aboriginal lady and I enjoyed meeting man.
We had a good discussion about her depression.
And at the end of the interview, she asked me if I’d recorded the interview, and I reassured her that I hadn’t, because we don’t.
And she actually was disappointed.
She asked her, why did she not want to Why don’t you want it recorded when she told me what she’d never been on television and she’d really enjoyed the interview and she wanted to share her whole community.
So, you know, that was a big lesson for me about how about the attitudes of patients and the fact that How valuable this type of interaction can be.
That’s really fascinating.
Are there any exceptions to that I’m thinking about, for instance, patients who are autistic or who need more cues then you might get through this screen other people who are struggling.
With Are there any just general subsets of the human population who have a harder time with this?
There really aren’t I mean, the only people who essentially can’t use this and can’t can’t use this approach?
Well, are people who you know who refuse to, you know who won’t use technology full stop.
Or who are people who may be actively violent themselves or to other people at the time, causing causing harm or damage.
But apart from that, really, all types of people can manage this environment very well.
And in fact, there is a group of people where it’s better honestly, to be seen on video than in person.
So So children just love this.
This is totally normal, okay?
And they can’t understand why they can’t see their doctor like this all the time.
Okay, that’s how they see their friends, and obviously not just children but the younger generations, the Gen Z group and the but the other people who actually are like this better Interesting combination of people,celebrities, people who really want extra privacy who want to be seen at home and who don’t want to go to some news clinic.
I personally see a lot of physicians as patients.
They would much rather generally see me on video than they would come Come to my clinic.
The there’s people who are anxious or avoidant or agoraphobic and stuck at home, obviously in COVID.
That’s a huge issue where people can’t go out of their homes so this is a better way of actually getting treatment.
And then the other big group that we’ve found over the years through research, is veterans and patients with post traumatic stress disorder.
Because the nature of post traumatic stress disorder is that people become avoidant.
They tend to not want to go out and meet other people.
They tend to stay more at home.
And so it’s actually a good way of treating them on to see them on video and potentially, ultimately the aim of that might actually be to get them to come and see you in person.
So reversing that The normal expectations.
That’s really interesting.
Let’s talk for a minute here about the industry as a whole and how it’s changing because of the pandemic world that we’re in.
You had mentioned that doing Psychiatry and psychology remotely has taken off, of course, for obvious reasons.
I know that before this moment, there were some real challenges to tell psychiatry and one of those was recruiting.
It was hard to find enough therapists who were available to do it for the demand for For video therapy for reasons that you just explained a lot of demand, people really wanted to do it.
Maybe not a lot of practitioners set up to be able to do it.
I guess this is a long intro to me asking, do you think that there have been regulatory or sort of structural changes that have allowed us to do this because we kind of threw everything up in the air and said, You know what?
We’re just going to use Facetime.
How is the industry changed,
yet nothing but there have been actually massive but regulatory changes as a result of COVID.
And the need for this to happen and it’s very interesting actually, that the federal government knew exactly what the barriers were that they had in place previously, and they’ve removed them all.
So there were barriers about about licensing.
You, Used to have to be licenced in the state that the patient was in that’s essentially gone now.
There were barriers about where the patient was situated many as many situations they had to be in a rural area that’s gone.
There were barriers about prescribing of particularly controlled substances.
So you didn’t used to be easily able to To prescribe for addictions, for instance, or stimulants for children with ADHD.
Those have gone and there were some barriers around technology and privacy.
And whilst those barriers haven’t gone.
They’re still there.
The federal government has essentially said that they’re not going to go and try and chase anybody legally if they’re not using fully HIPAA compliant technologies for at least the period of time that the current emergencies and In place now, people like me and many of my colleagues want these barriers to remain down because the the removal of the barriers quite honestly has been the single biggest stimulus to allowing people to To use to capture and similar approaches.
Uh,so anyone who’s watching this who knows a congressman, talk to them, please.
There is certainly some some work going on.
Congress at the moment, looking at trying to keep those barriers down permanently.
And it seems to me that now in this moment, I guess, if you were going to talk to somebody who’s looking for help, saying I really do think I need help right now and there are a lot of reasons people might be reaching out for help.
That because those barriers are down, what’s the best way to go find somebody you can get that help from So I think I mean, the first way is there’s a number of really good websites out there that you can go on that will look at different individual disciplines.
Clearly you should go to your insurance and look at who.
They who’s in their networks.
And you’ll find out that most mental health professionals actually do provide video treatment, because in reality, if they don’t, they’re really not goNNA get many patients.
So I would just go through the normal processes you go, you go through, spend a bit of time on Google And look around and it shouldn’t be too hard to find people.
Now the difficulty right now quite honestly is that in COVID the majority of mental health professionals and I’m an example are completely flat out.
We were already a shortage sort of set of disciplines before COVID not surprisingly and sadly We know that during COVID, the rates of anxiety of suicide of domestic violence of alcohol and substance abuse have all gone up and there’s lots of documentation on that and clearly the patients who we were seeing beforehand Have to a certain extent many often become more anxious because they’re trapped inside and unable to use the normal behavioral approaches to helping themselves.
So, the downside To the opening up of the system is the the nature of our current problems with COVID.
Is that you know, there’s there’s probably ultimately a greatest shortage.
Of therapists even though those easy access to them?
What about privacy within the home?
In this moment, you’ve so many families who are in confined spaces needing advice from outside that very tight group of people.
How are patients dealing with that and taking advantage of technology?
For instance, do you have a lot of patients who go sit in their car?
What’s your advice on on navigating that?
My advice actually is to go and sit in the car.
And, I think the car is the new therapy room.
And, I’ve seen many patients in their cars and they just take their phones or their iPads onto the car or, and they all come from there using whatever WiFi they’ve got.
And, that’s a very private area.
Now clearly, if you can’t go in your car, then it is a matter of trying to find a private room or a private space.
The beauty again of most video conferencing systems is that you can literally no see your doctor in the restroom if you want to and you just put up a different.
Background and pretend that you’re sitting overlooking the Golden Gate Bridge.
So, so I mean the beauty of the system is that you can disguise where you are at both ends and, and so sure you need to find a space that’s comfortable and private And but most people can actually do that.
It was a little bit of imagination.
It seems like we’re just on the precipice of some real positive change here and I would like to sign off but I would like to sign off by asking you Dr. Yellowlees.
What’s the best way to find out more about all of this expertise that you have?
I know you’re a published author.
How can people get a hold of your wisdom Sure well thank you very much.
I mean I’ve written several books I mean the the best place to go that actually is to my personal website which is Peter yellowlees.com.
And I’ve written books on tele psychiatry as well as on clinician well being and and also physician suicide.
Which is an area of interest of mine and a topic of great importance, but probably not top of the list of the topics to be discussed today.
Thank you so much for your time and we’ll let you get back to the business of helping people.
Thanks very much.
Thank you very much indeed.
Very nice to speak here.