Telehealth Best Practices: Dr. Claudie Jimenez of CleanSlate Centers On How To Best Care For Your Patients When They Are Not Physically In Front Of You
An Interview With Luke Kervin
Emphasize to patients how imperative it is for them to be “present.” People multitask while they’re on their phones or laptops all the time. They make video calls while driving, shopping, eating, etc. But it’s hard for providers to do their jobs when patients aren’t truly engaged — let alone address the privacy issues that arise if the patient is in a public place.
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 Claudie Jimenez.
Claudie Jimenez, M.D., M.S., is the Senior Vice President of Medical Operations at CleanSlate Centers, a national medical group that provides physician-led, office-based treatment for individuals with opioid and alcohol use disorders. She saw many aspects of addiction during her residency in Emergency Medicine and was subsequently drawn to become board-certified in Addiction Medicine. Dr. Jimenez recognizes that addiction is a chronic disease that affects the mind, body, and spirit, so she advocates for a big-picture, integrated approach to help those who suffer from it. She works to ensure the delivery of the highest quality mental, behavioral, and addiction services at the lowest cost to those seeking a path to long-term recovery.
In addition to her board certification, Dr. Jimenez earned her master’s degree in health management. She is the President of the Indiana Society of Addiction Medicine and has published several scholarly articles and book chapters on her work in Emergency and Addiction Medicine.
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?
Sure! After studying medicine at the University of Texas Health Science Center at Houston, I trained in Emergency Medicine at Parkland Hospital. Because Parkland is a Level 1 trauma center, I had opportunities as a resident and attending physician to treat all kinds of patients from all sorts of backgrounds. I was drawn to the fast-paced environment of evaluating patients and making diagnoses.
From that experience, I developed an interest in quality management. I embarked on administrative roles at several healthcare organizations around New York, but soon realized I really wanted to see patients again. I saw the huge need to help and serve patients with addiction and substance use disorders. So, I did my fellowship in Addiction Medicine at St. Luke’s-Roosevelt Hospital and became the medical director for inpatient units there. But my heart was set on doing outpatient medicine, so I became the medical director for a methadone clinic in East Harlem. Then, after moving to Indianapolis and working at an inpatient addiction treatment center, I was happy to get back into outpatient addiction medicine with CleanSlate.
Can you share the most interesting story that happened to you since you began your career?
You know, no one single story stands out. We took care of a lot of patients who had addiction-related problems when I worked in the emergency department (ED), but ED physicians only get to see patients for their immediate conditions. I never had a chance to follow up with any of them to get help for their substance use disorders.
I firmly believe that if we take care of patients’ addictions, we can also take care of many of their other health conditions. I’m a “big-picture” person, and addiction medicine is very much a “big-picture” specialty. We consider multiple aspects of each patient’s life, not just a single issue. The idea that we’re treating mind, body, and spirit appeals to me.
Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?
“Do unto others as you would have them do to you.”
Every life has value and purpose and it’s important to be intentional to treat others with the same kindness and respect that you wish to receive.
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?
It would be tough to pinpoint just one person for whom I’m grateful. Many, many people have helped me along the way.
The excellent attending staff at Parkland Hospital were invaluable, teaching us how to care for very sick patients. I also had a great mentor who taught me how to see the big picture when I moved into administration. He showed me how to contemplate all sides of an issue — such as who could contribute and who might be impacted by quality measures, new processes, and other aspects of change management. And I had excellent mentors in addiction medicine, too. They taught me so much about addiction and the patient population affected by this chronic disease.
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 from 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?
Yes, there are clear advantages and disadvantages to telehealth. One significant benefit providers notice from having a patient right in front of them is the personal connection they can make. Although you can see a patient’s face and hear their voice via telehealth, there’s an intangible connection you get from being in the same room with somebody.
Being in the same room also makes it much easier for physicians, recovery coaches, and other providers to pick up on nuances. You can get a general sense of how someone is doing and feeling over a monitor, but you can’t always see the gestures and other fine details you notice when you sit together in person.
Finally, with Addiction Medicine, safety and control factors must be considered. For example, in the clinic, we can control who does — or doesn’t — accompany a patient into the room during their visit in the clinic. During a telehealth visit, we’re not always aware of other people in the room with the patient. Sometimes, the clinic is the only safe, calm environment a patient experiences.
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?
As with many other specialties, the physical exam is a sizable challenge we face when a patient isn’t in the same space as the provider. Even though many people categorize Addiction Medicine as behavioral health, parts of the physical are very helpful. Unfortunately, you can’t always get those through a monitor.
For example, it’s essential to be able to monitor a person’s substance use or non-use objectively. That usually requires a drug screen using either a urine sample or an oral swab. There are different methods for collecting samples, but few studies have validated which are the most accurate and reliable for telemedicine patients. Our experience is that collecting a specimen in a more controlled environment like the clinic brings greater assurance of a reliable sample.
I mentioned earlier that addiction medicine involves treating the mind, body, and spirit — and all three pieces are equally important. So, challenges can arise in each sphere when the patient and provider aren’t together in the same space.
From a behavioral standpoint, for instance, isolation can be a significant risk factor for relapse. The social aspect of coming to a group session and chatting with others by the coffee maker — or just coming into the office for a visit — can play a key role in recovery. That’s hard to duplicate over a telehealth platform.
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.)
Emphasize to patients how imperative it is for them to be “present.” People multitask while they’re on their phones or laptops all the time. They make video calls while driving, shopping, eating, etc. But it’s hard for providers to do their jobs when patients aren’t truly engaged — let alone address the privacy issues that arise if the patient is in a public place.
So, we impress upon patients that a telehealth visit is a real doctor’s visit that includes private information we’re not allowed to discuss in a public area. We tell them, “This is your appointment. We don’t expect other people in the room with you.” We explain how important it is to their recovery that they find a private, quiet place for the visit and that they be mentally present and engaged.
Be sure to balance in-person visits with telehealth visits to maximize the benefits of both. Providers have to be careful not to rely on telehealth for every visit. While telehealth can be beneficial — especially for patients who have a hard time traveling into the office or require more frequent touchpoints — it can also be isolating for patients to see their providers and peers only through audio/video. Establishing personal connections is more difficult, and we can’t guarantee patients are in a safe, optimal location during a telehealth visit. We risk unintentionally limiting patients’ tools for recovery if we only conduct telehealth visits. Therefore, we must strike the right balance of clinic visits and telehealth visits for each patient.
Dedicate staff and time to ensure patients understand what’s necessary for a successful telehealth visit and are correctly set up. For example, discuss whether they can access a computer or the right type of phone. Ask if they have wi-fi, or if not, enough minutes on their phone. It takes about 15-minutes to walk patients through the technology download process.
Make sure patients think through logistics. Patients may not know or think about the logistics, so providers need to ask the questions and help patients set up in an unhurried manner.
Manage patients’ expectations. During COVID-19, when most patients weren’t familiar with telehealth, we found many of them expected their doctors to appear on the screen as soon as they clicked on the link. When that didn’t happen, they would leave — which meant we had to quickly follow up to try to get them to reconnect.
From that experience, we’ve learned to clarify for patients that “virtual” doesn’t mean “instantaneous.” We now make sure they’re aware they may have to wait in a virtual “waiting room” for a few minutes while their doctor finishes with another patient, just as they would in the clinic.
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?
Telehealth offers new opportunities to expand access to care. That benefit is crystal clear. But, in my mind, the biggest advantage of telehealth is the ability to reach out to people you might not otherwise be able to reach.
For example, let’s say a patient missed their appointment and you’re worried about their welfare. Telehealth gives you a way to connect with them that’s better than an audio-only phone call to try to get a sense of how they’re doing, their environment, and whether they’re safe.
Again, in addiction medicine, it’s all about making that connection. Telehealth enables more outreach with fewer logistical hurdles for patients to navigate. There’s an advantage to checking in with patients more frequently vs. waiting for them to come back into the office. It can be especially valuable for patients who would benefit from multiple touches, such as a somewhat unstable patient.
Plus, keep in mind that face-to-face visits may feel a bit scary for some patients with substance use disorders. Telehealth may be a more comfortable option for them to utilize in some cases. However, as I noted earlier, we must be careful as medical professionals not to fall into the trap of conducting every visit via telehealth. There is a social aspect to coming into the office that’s incredibly important to recovery. Telehealth is a great tool, but it’s not the only tool we should use.
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?
I don’t have a personal preference, but we’ve found that video-plus-audio tools are much better than audio-only telehealth. Even telephone calls are better than not connecting, though, because addiction is a chronic disease requiring chronic disease management, which means many touchpoints are involved. That’s the nice thing about telehealth; it helps patients with daily logistics. You don’t want to make recovery more difficult, and telehealth is one way to ease and support patients’ recovery.
If you could design the perfect Telehealth feature or system to help your patients, what would it be?
It would be easy for patients to download and navigate but also easy for providers to maneuver through — especially if they’re switching between in-person and telehealth visits. It can be cumbersome for providers to get out of one technology system and into another, so the perfect telehealth system would make it simple for providers to switch back and forth.
A good system would include audio and video. High-definition screens that really allow you to see details from a physical exam standpoint might be worth the extra cost in some situations. In addition, I like systems that offer prompts — such as, “You’ll see the doctor in 10 minutes…5 minutes…3 minutes.” I’ve experienced that in other places, and I think it would be helpful for patients.
The social piece is the one thing I don’t know how to replicate with any technology. Seeing everyone on-screen during a group session just isn’t the same as connecting with peers during a break when in person.
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, as discussed earlier, patients tend to get the best results from their telehealth visits when they understand two things:
they should be fully present for their telehealth appointments — just as they are for in-person visits, and
they should be in a good, therapeutic physical environment — a private, quiet, and safe location.
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?
For this specific patient population, it’s hard to say which virtual tools might be beneficial vs. potentially harmful. A key part of addiction medicine is teaching people how to live successfully in reality. So, virtual tools might be useful for setting up role-playing scenarios to help them in a controlled environment. But could those same tools also become a trigger for some patients? More study is needed on these types of tools in Addiction Medicine
Is there a part of this future vision that concerns you? Can you explain?
Yes, there is a lot we don’t yet know about how addiction and recovery might be impacted by evolving virtual, augmented, or mixed reality technologies. The body-mind-spirit aspect of addiction medicine is somewhat unique. We’ll have to be careful going forward, and take an individualized approach based on what each person can tolerate in their recovery. More research must be done to better understand the implications.
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. :-)
The first thing that comes to mind is encouraging everyone to live by the mantra, “Treat your neighbor as yourself.” People say it a lot, but how powerful would it be if everyone lived it!
How can our readers further follow your work online?
The best way to follow me is through my LinkedIn profile.
Thank you so much for the time you spent doing this interview. This was very inspirational, and we wish you continued success.
