Telehealth Offers Flexibility, But Clinicians Should Verify Patient’s Location Before Treatment

Telehealth reduces barriers to accessing mental health treatment, but clinicians should use caution when treating patients remotely to ensure the patient isn’t across state lines, said Amber Hoberg, NP, Centric Physicians Group, San Antonio, Texas, and Psych Congress steering committee member Edward Kaftarian, MD, CEO of Orbit Health Telepsychiatry, Encino, California.

In this discussion at Psych Congress 2021 in San Antonio, Texas, Hoberg and Dr Kaftarian also exchange views about whether telepsychiatry is superior or inferior to in-person treatment and how it impacts both the patient’s and clinician’s life.

In the previous part 1, they explore what clinicians can learn about their patients during telepsychiatry visits while ensuring confidentiality and adequate privacy.

Read the transcript:

Dr Edward Kaftarian: True or false, telepsychiatry is worse than on‑site care.

Nurse Amber Hoberg:  That's a loaded question.

Hoberg:  I would say it's true and false. Let me give the reason why. The reason why I think it would be false, that it's better than on‑site, is because sometimes we do need to see patients. There are times when I'm doing writing skills or things that I have to manipulate a patient. Or I have to be able to really see the patient and touch them. To be able to do that, trying to do it telepsychiatry can be a little difficult.

Oftentimes, I like the hybrid version where I see patients telepsychiatry but occasionally will see them in my office, just for those particular purposes where I need to do something, where I need them to write something or need them to be able to manipulate to see what's going on, if there's any kind of movement disorder, or any issues regarding that.

I believe it is better than sometimes in‑patient because, again, my no‑show rates have gone down. I don't have to travel. I can be multiple places in one day seeing patients, which I love.

I also like the fact that I can meet patients during their crisis, be able to join them, and be able to help them through that and get them to where they need to be, all in the same day while I'm seeing patients. I do believe in some ways it has more benefits than being on‑site.

Dr Kaftarian:  You don't love being stuck in traffic?

Hoberg:  No, I do not love being stuck in...

Dr. Kaftarian:  Wow.

Hoberg:  ...especially around here. It's crazy.

Dr. Kaftarian:  I'm from Los Angeles. So it's a huge factor there.

Hoberg:  Oh, that's even worse.

Dr Kaftarian:  I can't imagine having to cross the county of Los Angeles to see my patients. Also, it's an opportunity for providers to live wherever they want.

Hoberg:  Absolutely. We can be on vacation in Hawaii and still see our patients. I love it.

Dr Kaftarian:  Right. What about situation where the patient goes somewhere? I had a patient the other day that I thought they were in California. Then I asked them where they were. They were in their truck. It was a trucker. He was in Oregon. I had to actually reschedule because I don't have an Oregon license. Has that happened to you?

Hoberg:  That has not happened to me because most of my patients live in group homes. Or they're homeless, but they live in the same state most of the time. If they go missing, that's when we know that maybe they went somewhere else. I haven't had that happen to me. Maybe it's just the population of patients that I visit with.

But I can completely understand why you would definitely cancel that appointment and wait for them to get back in the state because of that licensing issue. I think that's important that maybe we do ask patients, "Are you at home? Where are you today? What state are you in?"

If we see that maybe they're in their car or going somewhere, making sure that they're in the state where we provide practice.

Dr Kaftarian:  Make sure that you check. Make sure that they're in the state you think they are because they might not be. Let's talk a little bit about how telepsychiatry has changed your quality of life.

Hoberg:  It's changed my quality of life greatly. I have five children. Of course it's changed my quality of life greatly that I can be there for my patients, but I have a stopping time when I can go pick up my kids from school and be able to be there as a mom too.

It actually has improved my quality of life, being able to be more present for my family but also be more present for my patients. I really love the telepsychiatry aspect in that regard.

Dr Kaftarian:  Are there any other advantages that you can think of with telepsychiatry in terms of the rapport that you can establish with the patient or any other aspects of telepsychiatry that are surprising that maybe people who don't do it...

Does anyone not do telepsychiatry? Come on. But for those few people who don't do it, what would you say is maybe something surprising about telepsychiatry that you wouldn't have thought?

Hoberg:  The things I think that are surprising is you can develop a rapport with your patient. You can surprisingly do just about anything in psychiatry with telepsychiatry. That was one thing that I had to overcome is, how am I going to do all these written things that I do on a daily basis?

It's really going back to that rapport that you build with your patient and asking the questions.

It doesn't always have to be a written form or written thing. It's really developing that dialogue with your patient, really listening to your patient, uncovering what it is that the problem, and then really working with your patient to solve those problems.

I think my listening skills have definitely become more in tune with working with telepsychiatry because it's something that you have to make sure that you're doing, that you're listening to your patient. You're understanding what they're asking. Then you're following that up with good care.

The things that were surprising to me is more that I can do more with telepsychiatry than I thought I could when I was in‑person visits.

Dr Kaftarian:  Listening is important in psychiatry?

Hoberg:  Oh my goodness, it's super important.

Dr Kaftarian: I'm kidding. Of course it is. Anyways, very nice to meet you...

Hoberg:  Thank you.

Dr. Kaftarian:  ...and to speak with you. It's definitely a world that is expanding with psychiatry and telepsychiatry. Hopefully, as psychiatrists develop their practice, they can incorporate technology as much as possible.

Hoberg:  Absolutely. I totally agree. I think it's a wonderful avenue to have. Not all patients like it, but most of my patients do.

Dr Kaftarian:  Thank you. This has been a great session. I thank you very much for your time.

Hoberg:  Thank you. Appreciate it.

Edward Kaftarian, MD is a nationally recognized psychiatrist and leader in the field of telepsychiatry and healthcare technology. Trained at the Johns Hopkins Hospital, he is board-certified in Psychiatry, Forensic Psychiatry and Addiction Medicine. Dr Kaftarian has served in a variety of executive roles within the California prison system, including chief psychiatrist, senior psychiatrist, medical director, and director of pharmacy. He is the founder of California’s Statewide Prison Telepsychiatry Program, which is the largest correctional telepsychiatry program in the world. Dr Kaftarian is currently the Chairman and CEO of Orbit Health Telepsychiatry, a company that provides telepsychiatry services to jails and prisons.

Amber Hoberg, FPMHNP-BC, is a Nurse Practitioner specialist in Boerne, Texas. She graduated in 2010, having over 12 years of diverse experience, especially as a nurse practitioner. She is affiliated with many hospitals including Nix Health Care System. Hoberg also cooperates with other doctors and physicians in medical groups including Centric Physicians Group Pllc.