The Telepsychiatry Advantage Episode 11

The Traits of Best-In-Class Telepsychiatrists

Introduction

In today’s episode, we’re going to talk about what makes a best in class telepsychiatrist. Here at Orbit Health we’re always searching for best-in-class. We want to work with the best psychiatrists, and we want to work with those that are best at telepsychiatry. So today’s episode, I’m going to tell you the secret of what makes a great telepsychiatrist. What are the traits, skills, techniques, experience? What makes for a best in class telepsychiatrist.

Even if you’re not going to work with Orbit Health, it’s a good idea to always shoot for being the best at what you do. If you don’t want to be the best at what you do, then why are you doing it? Okay. I don’t like to do anything unless I want to make it the best in the world. And that includes this podcast. So hopefully this is the best telepsychiatry podcast in the world.

Anyway, I got off on a tangent there, but let’s get back into what are the things that make for a really great telepsychiatrist? Best in class.

1. Be a Likable Person

Number one: be a nice person.

Okay, so use people skills. Psychiatrists that don’t have emotional intelligence are not really good psychiatrists unless you’re into research and that’s what you’re doing all day, you are talking to patients and you’re trying to make them feel better. So just think of it like, are you going to use the same people skills and emotional intelligence that makes you a likable person? So I’d say probably one of the most important qualities is are you likable? And that’s not just are you likable to the patients? Of course, the patients need to like you, because if they don’t like you, then they’re not going to benefit from talking to you. They’re not going to listen to what you have to say. They’re not going to follow your instructions if they don’t like you.

I know this is a very obvious concept, but sometimes we have to remind ourselves that you’re going to get a lot more from people, and you’re going to influence people more if you’re likable. So if you need more help with that, just read some of the books, like How to Win Friends and Influence People and those kind of books. If you have trouble being likable, and as I said, it’s not just about being likable to patients, it’s also you need to be likable for the people that you work with. So that includes the people on the other side of the camera that are not the patient. For the people working in the clinic, the telepresenter, the nurses, anyone you interact with, you need to be likable.

And you know what sometimes helps give somebody an appropriate compliment? Like, hey, it’s so fun working with you. You are really helpful. When I need something, you’re always on top of it. Now the key is to be appropriate with your compliment. Don’t say something that’s awkward or weird. Do I really have to tell you guys this? I mean, you guys know you’re smart, so being likable is the point.

Now, also, be likable with your employer or the person that’s giving you the contract. So in this case, if you want to be best in class for Orbit, then treat our Orbit admin people in a nice way and be likable to them too. So did I say it enough? I think I made my point make make yourself likable.

2. Master Your Technology and Setup

The next thing that I want to talk about that makes you a best in class telepsychiatrist, is make sure that everything is on point with your technology. For example, is your audio great? Is your video great? Is the background appropriate?

If you’re watching on video, I think my background is appropriate. I mean, I do have some fun things in there. I have the Mandalorian helmet there. I have my jujitsu guy, Jean-Jacques, so I got some fun things in the background that make it more personal and personable. But I also have my diplomas, a couple of my diplomas, and I have a lot of diplomas guys, and I used to just canvas my wall with diplomas, but that wasn’t really much fun. That was just like, hey, look at me, I got so many diplomas. But I think that people want a background that’s more personable, and it shows that I’m not just the diploma machine, I’m, you know, I’m a real person that has some interests too.

3. Communicate Clearly and Simply

Anyway, let’s get back on track here. What makes you a best in class psychiatrist? Be clear in your communication with everybody. So a lot of these qualities are going to apply for everybody. But I’ll usually start with the patient. Be clear in your communication with the patient. Make sure that they understand who you are. I mean you can say hello and not say who you are. I mean, that’s not very nice. I mean, if you’re at a party and you walk up to somebody and you just start talking to them and don’t introduce yourself and say who you are, then that doesn’t really bode very well for your people skills.

So again, use people skills. Introduce yourself, tell the patient the purpose of the call, the telepsychiatry appointment, and just make sure that they understand what you’re saying. Use simple language. Don’t try to use language that shows how smart you are. Okay, now that goes for telepsychiatry and in-person psychiatry. Just use language that’s basic that the patient can understand. Because what is the goal here? The goal is for your patient to get better and showing them how incredibly intelligent you are, I mean, you want them to know that you’re smart, but you don’t want themto feel like they don’t understand anything you’re saying because you’re using so many technical terms.

4. Use Non-Verbal Cues and Body Language

A third thing that we can do that makes us best-in-class is that we can use subtle body language, tone of voice to build rapport. Smile. You know, I sometimes forget to smile and people say, oh, hey, you got to smile more. I’m like, okay, yeah, I need to smile more. You’re right. So I’m trying to smile more. Now, I’m not trying to be weird about it, but I’m trying to smile more, and I think that that is helpful. And if you have a nice open body language, I think that that helps to. So if you cross your arms like this, for people that are watching this on video, that’s kind of putting a barrier if you look tense, if anything about your body language suggests that you’re not happy to see the patient and that you’re not there to help them, that could be a problem. So this could be subtle body language.

5. Build Relationships and Listen

Learn the names of the people that you work with. Okay, so this kind of goes back toward my favorite topic. Be likable. You know, I tell my kids, you got to be likable. You know, that’s an important quality. But part of that is learning people’s names and using people’s names often. So when you’re talking to your telepresenter, use their name. Talking to the nurse, use their name. Take a moment to know who you’re working with. What you want to do is you want to create goodwill. I always say that it’s better to have allies and enemies. I don’t actually always say that, but it’s something that I do think about. So it’s always good to have people on your side, and people will be more on your side if you’re interested in them.

So not only do you want to let your patient talk and listen to them, don’t talk over them, you want to also allow the people that you work with to talk and be interested in them. Don’t talk over your patient. That’s another one. It’s very frustrating when you talk to somebody and they are just waiting to talk. You can feel it like whatever you’re saying doesn’t matter, they’re just waiting. So don’t be that person. Don’t be the person that makes other people think that you think what you’re saying is more important. So what you’re saying is not more important, okay. Usually, it’s equally important. And make sure that other people are able to talk.

6. Maintain Humility and Clinical Knowledge

Don’t be arrogant. Again, this goes back to my favorite topic. You guessed it, be likable. Don’t be arrogant, okay? People don’t like doctors that are arrogant. People like doctors that are open minded, flexible, can work with the situation. Don’t just say, hey, this is the medication that you need and nothing else is going to work. Work with the patient. If there’s a particular type of medication that the patient has heard about and feels comfortable with, as long as it’s clinically appropriate, consider that medication. Obviously, it has to be something that makes sense for the diagnosis, but work with the patient. Listen to the patient. Listen to what’s important. Maybe they don’t want medication, you have to work with them in other ways. Again, I don’t be arrogant.

Okay, so there’s no point in being a psychiatrist if you don’t know anything about psychiatry. So you need to be knowledgeable. How to make a good diagnosis, how to treat appropriately. That is all a foundational element to being a best in class psychiatrist.

7. Handle High-Pressure and Agitated Situations

Another quality of a best in class telecine trust is that they’re calm and cool under pressure. For example, if your patient is yelling at you or is agitated, you yell back? I certainly hope not. Do you talk over the patient and tell them that they’re being rude? Well, usually not. Usually you don’t want to do that. Usually you want to use your people skills and redirect the patient de-escalate.

So part of being a best-in=class psychiatrist and telepsychiatrist is can you de-escalate the situation? What are ways that you can de-escalate your patient if they are agitated, if they’re angry? Well, drop your voice. Speak slower. If they yell, then you don’t yell back. You actually talk quieter with a more relaxed tone of voice. Keep your hands visible so that they know that you’re not doing anything else. Show that you’re listening. Let them speak without interrupting a rephrase when you have a chance to talk. Rephrase.

Now, if they get, you know, to the point at which you can’t even talk, then this is a situation that is beginning to be untenable, and you might need to involve other people in de-escalating the patient, maybe explaining to the patient that, hey, you’re really upset right now. I totally get it. I understand why you’re upset. Why don’t we take a few minutes to calm down and probably not use the word calm down. Take a deep breath, take a break, and then maybe we can continue the appointment later.

Now, if the patient is agitated to the point in which there is danger to themselves and others, then that’s a whole other situation. And we’re going to talk about that momentarily. Don’t argue with the patient when they are agitated. What you want to do is work with the patient to try to understand why they’re agitated. Rephrase their concerns. Show them that you care, that you’re listening, and oftentimes that will de-escalate the patient.

Sometimes you need to message the staff that are on site. So having a secure messaging system is important when you are talking to a patient. You want to message the staff that are on site and you want to say something like, hey, we might need to start ending the appointment here, the patient is getting more and more upset. And so these are ways that you can kind of manage an agitated patient, but your ability to manage somebody who’s not very happy, whether they’re agitated or depressed or emotional in some other way, your people skills and your emotional intelligence is going to be helpful in helping redirect, reframe, make the patient feel better, de-escalate. So these are all the things that make somebody really great at being able to de-escalate a patient, there are people skills.

8. Prepare for Emergencies and Crisis Plans

Now, as I said, sometimes the patient is a danger to themselves or others. And what makes a best-in-class psychiatrist? Somebody who is ready. They have a plan in place already before the appointment in case the patient becomes a danger to himself or others. So best-in-class psychiatrists will not wait until the patient is a danger before they have a plan. They will have a plan before, and part of that plan could be who you call. You know, somebody that knows the patient that can intervene, that can call 911.

Do you have 911 ready to call? And like I’ve said in the past episode, if you call 911 in your area, you’re going to get your 911. You’re not going to get the patient’s 911. So make sure that you know how to access 911 in the patient’s area. And that is often just a search on the internet that you can do. That’s fairly straightforward, but you do need to call the correct 911. And what does that mean. You need to know the patient’s location. And we’ve talked about this a lot in past episodes, so I won’t get into that anymore. But being able to manage an emergency situation is definitely a core competency for somebody who wants to call themselves best-in-class telepsychiatrist.

9. Maintain Thorough and Timely Documentation

Now, best-in-class psychiatrists also means that you document appropriately, and that goes for best-in-class telepsychiatrists. So the documentation would include did you have the patient’s identifying information? Did you confirm that this was the actual patient? Did you do a mental status examination? Did you do an assessment and a plan. So this isn’t your telepsychiatry residency program, so I’m not going to get into every single thing that you need to document in your note. But make sure to document the things that are required.

And I recommend if you want to be a best-in-class, telepsychiatrist to always document that you considered risk factors. That’s so important. And not only did you consider risk factors, but did you do something about it. So if you document that a patient is at high risk, but you don’t document what you’re going to do about it or why you chose a specific course of action, that’s not very good. If something happens to the patient, you look back and you see the doctor’s note says that the patient was a high risk of suicide, the patient then killed himself that night, and the note doesn’t say anything about what they did to manage the suicide risk, then that’s going to be a problem for you. And that suggests that maybe you’re not best-in-class.

So best-in-class again would be that you do a risk assessment pretty much every time you see a patient and you document if the patient has a higher risk, you document what you’re going to do about it. You want to make sure to sign your note. You want to make sure to turn in your note and sometimes doctors think that it’s okay to not turn their note in until the next day. And that would, in my opinion, immediately disqualify you for being best-in-class. Because the best-in-class telepsychiatrist is going to submit their notes the same day. That way if something happens, you don’t go back and have to recreate the situation, your memory is fresh about the patient, the note is available for people who want to know what happened during the appointment, and whatever action steps need to be taken. So best-in-class, turn in your note before the end of your shift, or at minimum before you go to bed that night. Okay, so that is very important, how to document your note. And we will get into more techniques about how to be a best-in-class psychiatrist when it comes to documentation. But for this episode, I think we’ve covered enough of that.

10. Troubleshoot Technical Difficulties Gracefully

I want to get a little bit more into it if problems happen. So we talked a little bit about what you do when a patient goes into crisis. And we’ve talked in past episodes about this as well. But what happens if the internet goes down? Let’s say your audio is bad. Your video is bad. Anything technically is bad. We said that a best-in-class psychiatrist makes sure that their technology is best-in-class. It’s working. But you know, sometimes even if you get the best technology and you test it, things go wrong, and the way that you handle yourself when things go wrong is really important. So if the video goes down, you know, you can continue your appointment with audio but you need to explain what this means. Maybe you need to have another appointment later when your video is back up. Maybe you can continue with audio if you’ve gotten enough of a look at your patient through videos. So there will be some judgment calls to be made about when you can continue with audio and when you need to reschedule.

Now, if the audio goes down, then that’s a bigger problem. And we’ve talked in the past about how it’s really hard to have an appointment when the doctor can’t hear the patient or the patient can’t hear the doctor. So this is when secure messaging comes in where you explain that, hey, we need to take a break while I try to fix the technology, or maybe the appointment needs to be rescheduled. So when things go wrong, so you have a plan to try to address it, and how do you explain it to the patient? Take ownership over it. Say, okay, I’m going to fix this. It looks like it’s a problem on my end. It might be a problem on their end and they would have to get some help to fix that as well, but how you respond when things go wrong is really important.

And that’s important in life. So guys, I’m teaching you life skills here. You should listen and apply some of these life skills to your life, even if it’s not psychiatry appointments. So when things go wrong. Do you get angry? Do you get frustrated? Or you just say, this is part of what it is.

This is part of what telepsychiatry is. This is part of what life is. Things are going to go wrong. And somebody once said, I really like this line that the problem with human beings is that they think that they won’t have problems. So when there are problems, do we get upset and say, oh, you know, there should never be any problems? Or do we expect that problems will occur and stay calm about it, because people are looking to you as the telepsychiatrist to show them how to behave. If you act in a panicked way, then they’re going to act in a panicked way. And that could be not only the patient, but your clinic on the other side. If they see that you’re panicking, they might panic as well. And do you think that that’s going to be helpful if everybody’s panicked? I don’t think so. At least one person needs to be calm and that person is you if you want to be best-in-class.

11. Follow Regulations, Licensing, and Rules

Now lastly, I’m going to talk about regulations and laws. So best in class means that you follow the rules and regulations. You follow what the medical board in your state is saying you need to do. You follow what the medical board in the state where the patient is, you follow what that medical board has to say as well. You have the appropriate licensing, you’re prescribing in an appropriate way, in an appropriate way, not an inappropriate way. Just to clarify that. And you’re following telemedicine rules. And sometimes that means getting an attorney to review your protocol.

Now when you work with Orbit Health, we want you to follow the rules. And that’s one of the things that is required to be best-in-class. Now, one of the things that you need to do is follow the appropriate way of prescribing. So when we’re talking about controlled substances, follow those rules. We have a four part series on the Ryan Haight Act, so pay close attention to that. How you prescribe controlled substances. You might need to get a special registration. We’ll see what the DEA says about that in the coming months, hopefully. But you need to have all the licensing, you need to have a license at minimum in the state where the patient is located, and you need to be up to date on license.

So, for example, if there’s CME requirements in your state medical board or the state medical board where you’re licensed, you need to make sure that you’re on top of that. And of course, don’t commit crimes. I don’t think that I need to tell you that, but it’d be pretty hard to be a best-in-class telepsychiatrist if you have a warrant out for your arrest. So I highly recommend that you follow your laws not just in psychiatry, but just be a good citizen, guys. Okay.

Summary

So at the end of the day, what is the best-in-class telepsychiatrist? It’s the same thing in many ways as a best-in-class psychiatrist or a best-in-class person. What does a best-in-class person mean?

You’re a good person. Okay, the class is human beings, and if you want to be best-in-class, you want to. You need to be a better human being than most human beings. And that means that you’re calm, youre patient, you care about other people, you follow the rules and you listen.

So I hope that this was helpful. If you want to be a best-in-class telepsychiatrist working for Orbit, we’re always looking to increase our talent pool, so please contact us at Orbit Health. But in any case, please try to be best-in-class and what you do, which is telepsychiatry. Keep raising the standard. And until next time. Good luck and raise the standard.