An interview with
Dr Frank Chow, Psychiatrist
July 22, 2020
mlcoa telehealth services, whether for a physical or psychiatric examination, are simply the independent medical opinions that you are used to drawing upon to support your clients, just delivered differently through secure video conferencing or a telecommunication platform.
Recently we have received requests to learn more about psychiatric telehealth appointments – how these assessments are conducted and wanting to gain a better understanding of the tele psychiatric method. To share some of his insights with you, mlcoa Consultant Psychiatrist, Dr Frank Chow, took some time out to answer your questions and share with us his knowledge and experience in conducting psychiatric independent medical assessments via telehealth.
Tell us about your experience with telehealth to date?
Telepsychiatry, as it is often referred to, is probably considered more of an “accepted” form of assessment in the medico-legal industry and in the treating world too. Assessing via this method has been around for a long time making it much more familiar for clinicians, patients and referrers. So for me it has been a very seamless and smooth transition from face to face to telehealth consultations. At mlcoa the staff have been very agile and adaptive in transitioning into providing this consultation model on a larger scale in a short timeframe. From an assessment point of view I have provided telepsychiatric independent medical assessments for a while, but in the current climate these are definitely being undertaken more frequently and I’m finding its’ been great with both the individuals I assess and the referrers being more accepting of participating in a telehealth assessment.
When you receive the paperwork prior to your appointment, what specifically are you looking for to determine the clinical appropriateness of conducting an appointment via telehealth?
What some people may not realise is that clinical governance and triage are critical components of the mlcoa telehelath assessment. Before we proceed with any assessment – physical or psychiatric in nature – the mlcoa team ensure the paperwork is not only reviewed by their team but also supplied to the doctor beforehand to ensure its appropriate for not just the mode of assessment, but any other considerations such as safety or duty of care.
Personally when I receive the paperwork, not only do I need to review it thoroughly to allow me to conduct the assessment, but for telehealth I need to review the paperwork for any risk factors. For example I look for any recent indication of an unstable mental state. In these instances I would ask for a support person to be present or close by, whose contact details I request, so I can contact them direct should they be required to assist the individual or call for any emergency support. This is a rare occurrence but a precaution that we take with telepsychiatry. I also ensure the mode of assessment is appropriate for the nature of the condition, weighing up whether the client being in their home is appropriate or they would be better assessed in one of our locations with staff readily accessible. I also look at the nature of their condition and perhaps any barriers to access, as in some instances tele assessment from their home may be better suited to them, allowing them to access a specialist in a more timely fashion. The key component here is ensuring if we proceed with telehealth it is safe and appropriate for the specific matter referred to me.
Yes, in cases where there is information indicating concern of the recent mental state of the individual being assessed I would ask that they be accompanied by a support person. I would enquire as to their relationship to the individual, and ensure they were appropriate in terms of maturity and dependability to manage potentially difficult situations. This is important to understand so we can ensure they are an appropriate support person and can be of assistance if required. I also should mention that sometimes a support person being present may not be sufficient, and it may be best for the person to be assessed in their local GP rooms instead, where there are trained medical personnel around to assist if need be, or I may again suggest an in person assessment is required.
What are the barriers you have encountered via telehealth and how have you overcome these?
Reliable technology is probably the biggest issue I have encountered. This mainly relates to internet connection and issues with sound quality. These issues are however minimised through the mlcoa team testing all connections prior to the assessments. The mlcoa team are also on hand to assist with any technology issues during the assessment if required. On the rare occasion where the technology issue cannot be overcome, and where I deem it clinically appropriate to proceed, I have transitioned to audio using a mobile phone. This however has only occurred if I am satisfied as to the person’s identity, and if I have developed enough rapport for this to occur.
Another barrier may be the location of the individual I am assessing. For example, is the person located in a private location free from current or potential distractions? To conduct a psychiatric assessment, it’s important that they are somewhere comfortable that allows them to speak freely without unexpected interruptions. I know the mlcoa team provide information to prepare for an assessment prior to this occurring, but if an issue such as this still arises on the day, I can usually discuss this direct with the individual, explaining why privacy is important, and together we identify a way forward.
Generally, no. I find as long as there is a test run done beforehand with the individual, usually the assessment goes quite smoothly. Sometimes there may be a delay with an individual joining the meeting and in these cases I wait for a few minutes and if the person I am assessing is not on the telehealth platform, I will contact mlcoa staff who will ring them and troubleshoot the delay. These issues are usually resolved quickly and does not significantly impact my ability to finish the consultation within the allocated time.
Does telehealth limit a psychiatrist’s ability to assess the nonverbal cues of the client and how is this addressed?
In my opinion the limitation is minimal. For any type of independent medical assessment, it is always critical to establish rapport, and when conducting an assessment via telehealth this is probably even more critical, however as a psychiatrist we are trained and experienced to do this. A critical part of our assessment is assessing nonverbal cues and we remain hyper vigilant of this in a tele setting. With technology today you can observe the individual during the assessment adequately so as not to impact our ability to do this. And in some instances, it can be more helpful to observe the individual in their home setting, which is often a more comfortable environment for them that can assist in the rapport building and putting them at ease.
Do you think it is worth waiting for an in-person assessment or can telehehealth be just as effective?
I think this will depend on the type of case. In my opinion most telehealth cases are just as effective as an in-person assessment. While it is not a limitation and not absolute, I do think for some specific cases a face to face appointment might yield more information such as secondary psychiatric injury from primary physical injury or cases with potential abnormal illness behaviours etc. Or as I mentioned earlier, part of the process includes a clinical review prior to proceeding, so if I deem their condition is not stable enough, or there are significant risks given they have no support accessible, I may recommend an in-person assessment. I think this is why it is critical that each and every case is assessed prior to proceeding and if in the rare occurrence a telehealth assessment goes ahead and I realise there are any limitations, then I would ensure I comment on this clearly in my report.
Overall what do you consider the pros and cons of a telehealth appt?
- Convenient for both parties (assessor and the individual being assessed).
- Minimal limitation and similar effectiveness to an in person appointment.
- Less confronting for the person being assessed.
- An ideal solution for individuals who have trouble leaving home or may be in a remote location – offering greater flexibility.
- Reliant on technology.
- The assessor has slightly less control of the client’s environment.
- The session can be disrupted by the surroundings of the client.
- May not be appropariate for individuals who are acutely unwell.
To learn more about Dr Frank Chow, telehealth, or to simply book your next telehealth assessment, please contact mlcoa on 1800 652 621 or firstname.lastname@example.org