Telehealth Best Practices: Melanie Silverman of Pacify On How To Best Care For Your Patients When They Are Not Physically In Front Of You

Listen First — One of the main frustrations for new parents breastfeeding is that they don’t feel heard. It’s imperative to listen to their entire story before offering any advice. Once they are done with their story, acknowledge that their journey has been challenging and you are here to help. At Pacify, we make sure to support new parents regardless of their feeding questions or choices. We are not in the business of making any parents feel guilty. Instead, we work to meet them where they are and help with a variety of feeding issues or questions besides breastfeeding.

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 Melanie Silverman, MS, RD, IBCLC.

Melanie Silverman is the Chief Clinical Officer at health technology company Pacify, which provides new parents 24/7 access to healthcare experts from their smartphones. Melanie is a pediatric registered dietitian and a board-certified lactation consultant with more than 20 years of experience in the hospital and private practice setting. She has committed her career to helping new parents access on-demand healthcare services to improve health outcomes and has built Pacify’s clinical networks from the ground up since its start in 2014.

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?

I started my career in Chicago, which is about the best place to start when you work in healthcare. I had the good fortune of working at The University of Chicago Medical Center for almost seven years. I was assigned to the pediatric burn intensive care unit my first day on the job. I remember saying to my manager that I could barely take care of my own sunburn, how would I take care of pediatric burns? She said, “You’ll learn!” And that I did. Truthfully, it was tragic seeing children who were burned, but it also was an incredible clinical experience because my goal as the unit dietitian was to work closely with the surgeons to make sure the children healed and continued to grow.

Because of my pediatric burn experience, I was moved to the Pediatric Intensive Care Unit (PICU) and then the Neonatal Intensive Care Unit (NICU). While in the NICU, I realized many new parents were feeding their babies with formula rather than breastfeeding. I was stunned at how low the breastfeeding rates were, especially when there are so many health benefits to a nursing mother and her baby. I became determined to make a difference and improve health outcomes for these patients. I found the three lactation consultants at the hospital and I asked (begged!) them to teach me everything they knew about breastfeeding. All three agreed and worked with me for three years. I then qualified for the exam, and became a lactation consultant myself.

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

In 2013, I left home in Southern California to work as a lactation consultant and dietitian for women in remote villages in Peru. Most of the women were living in extreme poverty, without indoor plumbing or any of the resources that we have in the United States. I remember a moment of clarity when one of the women asked the very same question — ”Am I breastfeeding correctly?” — that I had heard in my private practice from several Hollywood celebrities I counseled. That moment reinforced my already held beliefs that breastfeeding concerns are universal among new parents and that they all need and deserve breastfeeding support.

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

I’ve used the phrase “I’m going to hope for the best” several times per-week for about the last 15 years. I had to develop this mantra when I was raising two young children who were very close in age — they’re about 15 months apart. Parenting presented unforeseeable physical and emotional challenges that left me feeling out of control and anxious. The mantra helped because I committed to do everything I could for the children and then, I just had to hope for the best.

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 forever grateful to Michelle Armstead. She was one of the lactation consultants at The University of Chicago Medical Center who gave me the incredible clinical and emotional support to become a lactation consultant. To put it mildly, she was an amazing human being. She brought beautiful energy to her work and made lactation consulting exciting and gratifying. She acted like she won the lottery whenever she helped a baby latch! Sadly, she died about ten years ago. I was so moved by her influence on my life that I wrote her husband to tell him how much she meant to me personally and professionally. I know she would absolutely love Pacify and how we’re helping new parents all over the United States.

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?

The reality is, nothing will replace in-person medical or lactation care. Building a reliable and trustworthy relationship with a provider is at the core of any successful healthcare interaction. However, the landscape is changing and people are increasingly expecting access to virtual care. That isn’t to say that parents aren’t interested in physically taking their infant in for an important appointment, but rather they prefer virtual care for non-emergent issues. In fact, a study conducted by Sage Growth Partners in May 2020 showed that 60% of new moms expressed a strong preference to receive virtual lactation support as opposed to in-person consultations.

Telemedicine platforms like Pacify can compliment the support that parents receive locally while ensuring they have access to high-quality, around-the-clock support. Providers are in favor of these tools, too. They are aware of their limitations and what is and isn’t in their scope of practice.

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?

Lactation consulting is often very tactile. When the patient isn’t in the same space as a lactation consultant, it takes away one of the key tools. We fully admit that Pacify doesn’t replace in-person care, but the truth is most remote lactation support has happened for years over the phone. And while lactation consultants have provided wonderful support from a phone, video consults are such an upgrade! Our lactation consultants can absolutely help a mother to latch her baby, and video allows new parents to build a connection with their Pacify lactation consultant. We also have the data to show that Pacify helps to initiate and extend breastfeeding rates for the parents who use our service.

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. Work the Camera — In a virtual environment, it’s especially important for caregivers to appear friendly, caring and ready to help. There are a couple of good ways to compensate for the fact that screens can flatten interactions. First, use hand gestures and be expressive. Second, props like dolls or spoons are ideal because you can demonstrate the correct positioning in breastfeeding or how to introduce solid foods.
2. Be Ready to Offer Immediate Emotional Support — When parents call Pacify, they are struggling and frequently start to cry at the beginning of the conversation. It’s important for healthcare professionals in the telemedicine space to be emotionally prepared to drop in on a difficult moment. Many mothers who have trouble breastfeeding say they feel like they are failing — we must help them realize they are not! Helping them cope with the emotional stress of the situation can ensure they are able to listen and comply with recommendations.
3. Listen First — One of the main frustrations for new parents breastfeeding is that they don’t feel heard. It’s imperative to listen to their entire story before offering any advice. Once they are done with their story, acknowledge that their journey has been challenging and you are here to help. At Pacify, we make sure to support new parents regardless of their feeding questions or choices. We are not in the business of making any parents feel guilty. Instead, we work to meet them where they are and help with a variety of feeding issues or questions besides breastfeeding.
4. Prompt Other Questions — Patients using telehealth services may be nervous to ask follow-up questions because they may perceive they are taking up too much time. Prompting callers about other potential issues is an important step to give complete care.
   We actually encourage our lactation consultants to stay on the call as long as the parent needs. Our lactation consultants may ask if parents are going back to work soon or if they have questions about storing breast milk. They also check in about sleep and diet issues too. Our lactation consultants are always on the lookout for postpartum depression among new parents, and if we suspect there is an issue, we will help them locate the help they need.
5. Recognize an Emergency — Any healthcare professional working in telemedicine must recognize its limits in two ways. First, it’s crucial to know when the patient has reached the limit of what is possible to deliver via telehealth. Second, providers must recognize emergencies and advise the patient to dial 911. Telehealth providers are the first line of care — and can often solve the problem, and avoid prohibitive costs — but they must be able to recognize an emergency when they see one.

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?

The first and most important aspect of telehealth in the lactation space is the ability to have 24/7 access.

At Pacify, 60% of calls come in outside of normal business hours when other options such as clinics are closed. When a new parent has a question about breastfeeding, it’s an emergency. If they do not get their question answered, they risk losing their milk supply. A baby’s feeding schedule just won’t work with lactation consulting that’s limited to a 9–5 workday.

Second, telehealth removes the transportation barrier. Even with a car, it’s not easy to make an appointment, pack a newborn baby into a carseat, wait for a doctor and then travel home. This is even more of a challenge for new parents with limited transportation options! Telehealth has created an environment in which parents can find help, in the comfort of their own homes, the minute they have a problem.

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?

Live video chat has been a huge boon for telehealth. With video, lactation consultants can see a lot of what they need to provide good care for nursing parents. The use of props and hand gestures are essential in explaining different nursing positions or latching techniques. When the provider is dynamic, which Pacify lactation consultants are, a video consultation can provide the same warmth and connection as an in-person visit.

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

Our technology works beautifully, but sometimes there is a dropped call because of a cell service problem or a weak WiFi signal. Of course, we have protocols in place to reconnect with parents after a dropped call, but If I could design the perfect feature, it would be a technology solution that eliminates dropped calls completely.

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?

Sometimes patients, especially women, can settle for care that is less than optimal. If they have questions, but feel intimidated, they may leave a healthcare professional’s setting without getting their questions answered. In telehealth, like in any setting, patients should advocate for themselves. They shouldn’t be afraid to ask for what they need, or even switch providers if they don’t feel cared for and empowered.

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?

I could imagine virtual reality being incredibly useful for teaching parents about breastfeeding before the baby is born. We know this is already in the world to transform surgical training, but VR could take prenatal breastfeeding classes to a whole new level.

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

I think it’s important to realize that so much can be done through telemedicine, but also, only so much can be done. Telemedicine won’t solve every problem in the U.S. healthcare system and it won’t replace in-person care. But if people see it as a way to fill the gaps in the healthcare system where appropriate, it could drastically change health outcomes.

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. :-)

I would make Pacify available to every single new parent in the United States — for free. We know Pacify helps increase breastfeeding initiation and duration rates. Giving Pacify to every new parent would certainly save millions in healthcare dollars.

How can our readers further follow your work online?

I host an Instagram Live event every Friday at 2:30pm EST on @PacifyApp. Please follow us @pacifyapp on Twitter and Facebook too! And keep up with the latest via our newsroom.

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