Telehealth Best Practices: Dr. Rebecca Chermak On How To Best Care For Your Patients When They Are Not Physically In Front Of You

Make sure your connection is HIPAA compliant and secure: in the field of psychology, confidentiality and security are the first principles drilled into you as a trainee; therefore, using a platform that is secure can help patients feel comfortable, while also meeting safety standards.

One of the consequences of the pandemic is the dramatic growth of Telehealth and Telemedicine. But how can doctors and providers best care for their patients when they are not physically in front of them? What do doctors wish patients knew in order to make sure they are getting the best results even though they are not actually in the office? How can Telehealth approximate and even improve upon the healthcare that traditional doctors’ visits can provide?

In this interview series, called “Telehealth Best Practices; How To Best Care For Your Patients When They Are Not Physically In Front Of You” we are talking to successful Doctors, Dentists, Psychotherapists, Counselors, and other medical and wellness professionals who share lessons and stories from their experience about the best practices in Telehealth. As a part of this series, I had the pleasure of interviewing Dr. Rebecca Chermak, licensed clinical psychologist.

Dr. Chermak is a licensed clinical psychologist currently working at a hospital-based Bariatric Center in addition to her own private practice in Tampa, FL. Since the start of the pandemic, she has been seeing almost 100% of her patients via telehealth and has completed over 2000 sessions via various HIPAA compliant platforms. Dr. Chermak specializes in helping adolescents and adults struggling with disordered eating, significant weight management concerns, anxiety, depression, and phase of life transitions via values-based living.

Thank you so much for joining us in this interview series! Before we dive in, our readers would love to “get to know you” a bit better. Can you tell us a bit about your ‘backstory’ and how you got started?

Thank you for having me! I have this one distinct memory in high school when I was helping a friend navigate a breakup with his partner and in the middle of the conversation he stopped me and said, “You know, you should really do this for a living someday.” At the time, I brushed it off because I was hell-bent on going to dental school, which now I look back on and realize how crazy I was because I hate the sound of those drills! Anyways, I decided to take a couple of psychology courses the first year of college and as they say, “the rest is history!” Ten years of school, clinical, fellowship and grueling exams later, I was finally a licensed clinical psychologist. I have never regretted my decision and have really enjoyed how the field has grown and developed in the last several years. I have had the opportunity to work in many different settings with various populations.

While gaining experience with a variety of treatment settings, interventions, and patient populations, I have always focused my interest on eating disorders and related body image, weight management, and quality of life. At the beginning of my career, I started my clinical work at The Renfrew Center, an inpatient eating disorder treatment center for women. During my training, I continued working there while also heading the Eating Disorder Awareness Association, working alongside eating disorder awareness initiatives in the community, and doing substantial research in eating disorders. During my internship at a college counseling center, I was part of the Eating Disorder treatment team and continued my work with this population during fellowship training. The last few years I have been working on the other side of the spectrum, working with bariatric patients with severe morbid obesity who are undergoing bariatric surgery and significant weight loss to help improve their medical conditions and quality of life. It has been fascinating working with both ends of the spectrum. You learn in those moments how amazing our bodies are and what they truly are capable of when in survival mode.

Can you share the most interesting story that happened to you since you began your career?

Being a psychologist has its perks: I hear the most interesting stories that you truly wouldn’t believe while getting to know people from all walks of life. The downside? Confidentiality does not afford me the right to share any of these stories and respecting my patients’ confidentiality is my utmost priority. But you can be rest assured, humans are very interesting creatures!

Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?

This question is not easy! There are so many great quotes out there that resonate with me. One I have found to be particularly poignant this past year is by Charles Darwin: “It is not the strongest species that survive, nor the most intelligent, but the most responsive to change.” Life really throws us curve balls, I mean #2020. The COVID-19 pandemic was a collective traumatic experience we will never forget. It impacted every single person on this planet in one way or another. It taught us how important being adaptable to change really is. It taught us how being resilient in the face of fear and evolving data can help to navigate each passing day. What we have seen time and time again is that life is not predictable. The global pandemic was just a huge example of that. What it also reminded us of, though, are the benefits of adaptability and the need to be responsive to change in order to survive. The rapid implementation of telehealth has been such a great example of how we were able to figure out a way to keep things moving despite a huge change.

None of us are able to achieve success without some help along the way. Is there a particular person who you are grateful towards who helped get you to where you are? Can you share a story about that?

I am fortunate to say that there are many people who have been in my life both personally and professionally who have constantly believed in me and pushed me to be the best clinician I can be. One that stands out is my former clinical director, Dr. Cathy Moonshine, while on internship Pacific University’s Comprehensive Health Center in Portland, OR. As an intern under her leadership and supervision, I grew to have a lot of responsibilities in clinical practice, training students, outreach development, and clinic management. Through these experiences she trusted me, gave me independence to flourish, taught me leadership, and believed in me as a psychologist, all while not taking life too seriously and believing in a work life balance. It was during this year that helped me believe that I deserved my seat at the table within the psychology field and I could make a difference in this world.

Ok wonderful. Let’s now shift to the main focus of our interview. The pandemic has changed so many things about the way we behave. One of them of course, is how doctors treat their patients. Many doctors have started treating their patients remotely. Telehealth can of course be very different than working with a patient that is in front of you. This provides great opportunity because it allows more people access to medical professionals, but it can also create unique challenges. To begin, can you articulate for our readers a few of the main benefits of having a patient in front of you?

As a psychologist, we have been trained to be experts in human behavior and data we use to help understand patients is their body language, their tone of voice, and how they explain and relate to topics they’re discussing. Obviously when in person I am able to see the whole picture better and notice the energy in the room in a neutral space with little to no distraction. All pieces of data help to conceptualize the patient’s presenting problem and come up with the most appropriate treatment plan moving forward.

On the flip side, can you articulate for our readers a few of the main challenges that arise when a patient is not in the same space as the doctor?

Without a doubt the biggest challenge I have faced when a patient is not in the same space is distraction in their environment. Another common challenge is poor connection and technology troubleshooting that takes time away from the appointment. For the psychology field more specifically, ambivalence about therapy can lead to more disconnectedness and the patient may be unwilling to actively participate in therapy virtually. This is particularly true with adolescents who have been encouraged to be in therapy by their caregivers and may be easily distracted by their phones or TV mid virtual session. On a more serious note, assessing safety, self-harm, and suicidal ideation can be very challenging in a virtual session. It is much easier to assess self-harm wounds or help a patient get to the psychiatric hospital when they are safe with you in your office; however, in a virtual visit there are barriers that may make it much more difficult. Having up-to-date emergency contact information is crucial for psychiatric or medical emergencies.

Fantastic. Here is the main question of our interview. Based on your experience, what can one do to address or redress each of those challenges? What are your “5 Things You Need To Know To Best Care For Your Patients When They Are Not Physically In Front Of You? (Please share a story or example for each.)

1. Make sure your connection is HIPAA compliant and secure: in the field of psychology, confidentiality and security are the first principles drilled into you as a trainee; therefore, using a platform that is secure can help patients feel comfortable, while also meeting safety standards.
2. Make sure your platform is easy to use for the patient with minimal effort: there are platforms that only require the patient to click on a link versus downloading an app ahead of time, etc. This simplicity can greatly help with access and avoid technological issues that may impact the session itself.
3. Remind patients to treat it like a normal doctor’s office visit: find a quiet and well-lit place, dress appropriately, have minimal distractions, and if possible, good wifi or phone signal. There have been many patients who unfortunately treat telehealth visits like phone calls with their friends and may try to multi-task by continuing to work, grocery shop, or drive.
4. Stay present: it is easy to get distracted yourself or for the patient to get distracted. This can be especially true if they are already ambivalent about therapy or experience social anxiety, as having distractions can be a way to avoid the vulnerability of therapy on either side of the screen.
5. Have caregiver/spouse present for session if patient consents: when working with patients who are preparing for bariatric surgery, it is particularly helpful to have their caregivers/spouses also sit in on their sessions to help properly relay necessary information to help support the patient at home to meet their goals.

Can you share a few ways that Telehealth can create opportunities or benefits that traditional in-office visits cannot provide? Can you please share a story or give an example?

Improving access has been by far the best thing to come out of telehealth. Telehealth has created the opportunity to see patients who live very far away, do not have reliable transportation, do not have alternative childcare, or have other limitations that make it challenging to attend in person visits. This has disproportionally affected BIPOC and low-income patients. Offering telehealth has greatly improved access to populations that have more barriers. With telehealth capability, there are much fewer late cancellations or patients just not showing up to appointments since many barriers are no longer issues to manage. For example, we are one of the only hospitals in Florida who offer bariatric surgery for adolescents, so as a result, we have patients coming from very far away and it makes it very challenging for them to attend all their appointments in person. Telehealth visits open the door to these patients to access our program. Additionally, during the course of the pandemic, telehealth has afforded the opportunity to continue to see patients in a safer way, eliminating risk of exposure of potentially contagious illnesses. These two benefits are arguably the biggest reasons to continue the use of telehealth as a staple practice in healthcare moving forward.

Let’s zoom in a bit. Many tools have been developed to help facilitate Telehealth. In your personal experiences which tools have been most effective in helping to replicate the benefits of being together in the same space?

Video video video. Having the ability to clearly see the patient (with reliable audio of course, too) is the best way to replicate an in person visit. It is particularly useful as a psychologist to be able to see non-verbal cues and body language as they help tell parts of the story the patient may not be sharing verbally. Psychologists are trained human behavior analysts and we rely on being able to get the whole picture. What is even more helpful in telehealth visits is the ability to not only see the patient, but to also see their environment, too. Patients are able to show me parts of their home that are relevant to treatment, such as a dedicated meditation space, or even introduce me to their spouse which I may not have had the chance to do in an in person visit.

If you could design the perfect Telehealth feature or system to help your patients, what would it be?

The perfect telehealth system would not require internet or one that can be used with limited connectivity. I know, I am asking for a lot here. But the biggest barrier to quality visits via telehealth is connection issues and not being able to see or hear a patient clearly or connect at all. I do not know the ideal solution, but I know the more we learn about the ways we can offer virtual medicine the better it will be!

Are there things that you wish patients knew in order to make sure they are getting the best results even though they are not actually in the office?

Yes! There are so many tips that can help make the appointment as successful as possible. The first and biggest piece of advice is minimize distraction as much as possible. Find a quiet place at work or home where you feel comfortable discussing personal matters. There have been several patients who have attempted to have a therapy session while still working, doing chores, grocery shopping, or driving in the car. Therapy is a practice that truly requires considerable focus and in order to obtain benefit, requires being open and present. Being distracted may also lead to missed information that is important.

There are many different platforms being used, some easier than others. We are all doing our part to try and make it as easy as possible but sometimes, technology just falls short. Being flexible and open to different platforms is part of the process we are all going through.

Lastly, being on time and prepared for your appointments will also help to make each session go as smoothly as possible. Have your battery fully charged, be on time for the virtual appointment, and have all necessary documents and a notebook near you if needed.

The technology is rapidly evolving and new tools like VR, AR, and Mixed Reality are being developed to help bring people together in a shared virtual space. Is there any technology coming down the pipeline that excites you?

Just this week actually I had the opportunity to try out a new telehealth platform that directly connects with our hospital’s electronic medical record. It has been really great to have everything in one system and it allows me to share my screen and show them specific information in their records which I wasn’t able to do before. I would imagine this will be even more useful for physicians who want to review test results and scans with their patients and can follow along together with the screen sharing feature. This can be a game changer with patients who have limited access to get to a doctor’s appointment in person or need to be seen right away.

Is there a part of this future vision that concerns you? Can you explain?

As humans, we are social beings and do well with physical human connection. What we are seeing in the last 20 years is the change in which we communicate since the internet really started to take off. The ways in which we communicate has grown exponentially which creates wonderful opportunities to reach far and wide; however, it is also isolating in other ways. In regard to telehealth, we have to be mindful of the delicate balance between offering medicine and in my case, psychotherapy, virtually in the comfort of patients’ homes versus the value of in person human connection. Nothing replaces being able to give a patient a tissue when they’re crying. Not being able to fully express my empathy towards my patients on the other side of the screen versus in person has been my hardest struggle as a psychologist and will always be the obvious downside to virtual connection in the future.

Ok wonderful. We are nearly done. Here is our last “meaty” question. You are a person of great influence. If you could inspire a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger. :-)

Well this isn’t related to telehealth at all BUT, throw out the scale and let go of the “fairy tale” mentality that perceived thinness and marriage are the only ways to be truly happy. Happily ever after starts with you, right now in this moment, doing something that sparks joy and continuing to just do those small things day-to-day that are meaningful to you. Success is not linear and does not fit within a box. In my view, success and happiness come from values-based living, being intentional, and spending time with those who believe in you.

How can our readers further follow your work online?

You can find me on instagram and twitter @doctorconfidential

Thank you so much for the time you spent doing this interview. This was very inspirational, and we wish you continued success.