The Telepsychiatry Advantage Episode 10

How to Completely Ruin a Telepsychiatry Appointment

Introduction

In today’s episode, we’re going to look at exactly what you should do if your primary goal is to ensure that your patient has an awful, miserable experience and never wants to book a follow up appointment with telepsychiatry again. Sometimes looking at the absolute worst way to do something is the best way to understand why the fundamentals matter.

So if you want to completely ruin a clinical encounter, here’s my five step guide.

Step 1: Lighting and Positioning

Step one: Sit with your back to a bright window. If you want to ruin the session right out of the gate. Make sure that the patient can’t see your face, and the best way to do that is put a massive, unshaded window directly behind you, so that way your patient will only see a silhouette and they will not see your features. The patient relies on your facial expressions to feel validated and safe, and by hiding your face in the shadow, you ensure that the patient feels like they’re speaking to an interrogator rather than a medical professional.

Step 2: Eye Contact

Step two: Never look at the camera For this step, when the patient is talking, stare off to the side where you’re documenting with your Electronic Health Record, anything that you can do to not look at the camera will give the patient the feeling that you’re not paying attention. Research into telemedicine shows that perceived eye contact is one of the most critical factors in establishing a therapeutic alliance. So when you’re staring somewhere else, instead of looking into the camera, it makes the patient look like you’re disinterested and detached. And if you want them to feel ignored, this is a highly effective technique.

Step 3: Audio Environment

Step three: create a noisy background To really guarantee a terrible experience, pay no attention to your audio environment. Leave your office door open, keep your cell phone on high volume and so text notifications can ping loudly every couple of minutes. Our patients are often sharing the most vulnerable, painful aspects of their lives. As a core component of psychiatric care, the safety and confidentiality of the space that we create is really important. And if a patient is talking about severe trauma or other things that are bothering them, and they hear lots of noises on your end of the camera, like phone ringing, dogs barking, it just distracts the patient and makes it really difficult for them to continue their train of thought. And this will reduce the trust that they have in you and your ability to create a confidential, quiet space.

Step 4: Tech Preparation

Step four: do not check your settings on your computer before you start. Don’t check the audio settings, like the microphone, make sure that you’re not checking the camera, don’t check your internet connection, just start off and see what happens, maybe your session will start out on mute, where people don’t hear each other and keep it on mute so that the patient can’t hear you. I don’t make sure that your Wi-Fi signal is good. So that your video can freeze constantly. Because when technology fails, because of your setup, that looks unprofessional. And when you do this, don’t take any ownership over it. Don’t say that this is on your end, that it’s going to be fixed. Just let the patient wonder what’s going to happen, because that’s going to increase the anxiety of the patient, and that’s going to ruin this trust that the patient has with you.

Step 5: Background Noise and Data Entry

Step five type loudly without explaining why. In fact, make as many noises as you can on your end, whether it’s typing or shuffling papers, these kind of noises are picked up by the microphone more than your own voice. And so if you want the patient to not hear your voice, make all these extra sounds. This removes all human warmth from the interaction, and it turns a sensitive psychiatric evaluation into a cold clinical data entry transaction, guaranteeing that the patient feels like a checkbox rather than human being.

The AI Comparison

So if you want to do all of these things to ruin the appointment, go for it because we want to prove that AI is better than a human being. Because the way that you can make AI sound more attractive to the patient is by making the human worse. And so if we’re worse in the appointment, the patient is going to practically beg for AI eventually and will all be replaced. We will no longer have a job as psychiatrists because the AI will be better. The AI will come across as more compassionate, it’s going to come across as more professional. So do all those steps that I said, so that we as professionals, no longer have a place in patient care.

Bonus Round: Rapid-Fire Bad Practices

Now how about a bonus round, a rapid fire round of things that you can do to ruin the appointment?

Eat a full meal on camera. That way, the patient sees that you’re more interested in eating than listening to them, and it ruins the professionalism of the appointment.

Go mobile. Carry your laptop around the house, Do some chores. You know what? Just get in the car. Get into an Uber. How about that and go to the airport. And so that way the patient will be completely distracted by what you’re doing. They’ll be perplexed. And then when you get to the airport, go and see the patient from an airport lounge. That way, patients will see other people in the screen, and it will destroy the confidentiality of the appointment. So when in doubt and you want to ruin the patient’s appointment and experience, take your camera and move it all around.

Use a distracting virtual background. Set it to a moving video, for example. Like something very inappropriate, something very distracting. Make sure that the patient is more interested in the video background than you.

Dress unprofessionally. Show up in a hoodie or gym clothes to signal that you don’t take the visit seriously. You’re not a doctor after all, right? You’re just coming back from the gym. And this is how we dress when we go to the gym.

Take a personal phone call. Hold up your finger and interrupt the patient. And ask the patient if they wouldn’t mind if you answered this phone call. Because after all, you want to show that the phone call is more important than the patient.

Allow foot traffic. Position yourself so that other people can walk around in the background. We covered this when you went to the airport, but this can be done anywhere and in your office. Just have a printer set up close by. That way, people can come and get what they’ve printed and distract your patient. In fact, you’ll get an extra benefit because the printer will make a lot of noise and that will also be distracting for the patient.

Stare at your phone instead of the patient. So this goes along the lines of not looking at the camera, but instead looking down at your phone. We all know how fun it is, right? When we go out to eat with somebody and they’re looking down at their phone and they’re texting instead of being present in the moment with you.

So to ruin a patient experience, do that with a patient to

Drink from a massive mug. So there’s nothing more distracting than having a huge mug on your desk that you’re constantly drinking from. That blocks the camera and it might even have a saying on that, like, I love hamsters or whatever you want to say, and make sure that it’s very distracting for the patient.In fact, you can apply this to any object on your desk. Make it huge, and if possible, block part of a patient’s view of you with that object.

And lastly, just hang up on the patient abruptly. This will suggest that you are tired of talking to the patient, and you don’t care enough to do any kind of segue or say, what’s going to happen next. Just hang up. Don’t even say anything more than that. And that will give the patient a feeling that they’re not important.

Conclusion and Best Practices

In all seriousness, practicing telepsychiatry requires skill building. The screen doesn’t have to be a barrier to good patient care, and as a therapeutic alliance with the patient. You can establish rapport with the patient, but you want to do the exact opposite of everything that I just said. You want to make sure that your face is lit properly, so that the patient can see your face in your facial expressions. You want to look at the lens of the camera. You want to secure your environment. So that is private and confidential and quiet. You want to test your technology to make sure that everything’s working, and you want to do that ahead of time you want to communicate with the patient what’s going to happen? That way, you can build a strong therapeutic alliance and avoid it being the worst telemedicine appointment of all time.

If you’re a psychiatrist who wants to deliver high quality care. We at Orbit Health are always looking for excellent psychiatrists. We know how to support our doctors. Thank you for tuning in to the tele psychiatry advantage. And till next time, keep raising the standard.