From providing virtual therapy sessions to patients in the front seats of their cars, to sessions with patients who turn out to be in another state,
Dr. Sanjay Gupta
But key practice tips are emerging for the optimization of virtual sessions, said Sanjay Gupta, MD, chief medical officer of the BryLin Behavioral Health System in Buffalo, N.Y., during a presentation on the subject at the 21st Annual Psychopharmacology Update presented by Current Psychiatry and the American Academy of Clinical Psychiatrists in Cincinnati, Ohio.
Dr. Gupta noted that while “many pitfalls [may] occur,” an overriding rule that should be emphasized with telepsychiatry is that “[virtual visits] are held to the same standard of care as an in-person visit.” This “rule” needs to be followed diligently, he said, as the key difference in virtual visits is a reduced sense of the formality of a psychotherapy session.
With virtual sessions, the therapeutic experience “can feel kind of trivialized,” said Dr. Gupta, who is also a clinical professor in the department of psychiatry, State University of New York at Buffalo. He noted that it is crucial that “the sacredness of a private setting should not be diluted.”
Challenges in finding that privacy for some, however, lead to the issue of the “patients in cars” scenario, Dr. Gupta said. Still, he added, while psychiatric sessions should never be conducted when a patient is driving, the front seat of a parked car may, for some, be the most private setting available.
“For many patients, their car may be the only private place from which they can take a video call,” Dr. Gupta noted. “Perhaps they are at work and the only way they could fit in the appointment is by going out to their car on their break. Or patients may even be at home, but they’re not alone and need to go out to their car for privacy.”
If the car isn’t being driven, sitting inside it should be fine for virtual therapy, but even there, clinicians should retain a focus on the consistency of care regardless of the setting.
Meanwhile, psychiatrists can take key measures to keep things professional, at least on their end of the session.
Before starting, for instance, keep in mind the patient’s viewing experience, Dr. Gupta suggested. Tips he offered include:
- Keep the background of your video image subtle, with no distractions, such as windows looking out to an ocean or other distracting background elements.
- The camera should be above eye level to suggest a face-to-face conversation more effectively.
- Try not to have other browser windows open and look directly into the camera lens so that the patient knows they have your full attention.
- Try not to take notes or document in the electronic health record during the session, which also can give the impression of being distracted and not listening to the patient.