Telehealth Best Practices: Serena Chaudhry of Tulane University School of Medicine On How To Best Care For Your Patients When They Are Not Physically In Front Of You
Hearing each person’s opinions and preferences is so important and crucial for maintaining rapport. I was intentional about asking and responding to preferences at the outset of the pandemic. Some people didn’t trust the Zoom platform that we were using for sessions, others didn’t want to look at themselves. I started where people were at and revisited regularly.
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 Serena Chaudhry.
Serena Chaudhry is Assistant Professor of Psychiatry and Behavioral Sciences at the Tulane University School of Medicine and Clinical Director of the Early Psychosis Intervention Clinic New Orleans. She provides direct clinical care and oversees research, training and public health education at the clinic. Serena is a member of Physicians for Human Rights asylum network and has served as a medical expert to advocate for immigrants in ICE detention centers; she regularly provides psychological evaluations for immigrants and refugees seeking to improve their immigration status.
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?
Before I became a clinician, I worked at the community level organizing and educating around health, social and economic disparities. I loved being out and about meeting people in their communities and working towards system level changes. Though invigorating, the work was tiresome as systemic change often happens excruciatingly slowly. After growing exhausted, I pivoted and engaged my social work training in a clinical capacity. I started working as a psychotherapist addressing the impact of injustices on individuals. In sessions with patients I was able to see and support changes in thought patterns, feeling states and behaviors. The tangibility and pace of these changes was inspiring to me.
Can you share the most interesting story that happened to you since you began your career?
Fast forward several years, I land in a community mental health clinic, The Early Psychosis Intervention Clinic New Orleans, treating young people after their first episode of psychosis. In addition to providing treatment, this coordinated specialty care clinic launched a psychosis awareness campaign to help our local community, New Orleans, understand and treat psychosis. Upon the inception of the campaign, my partner at the clinic, Dr. Ashley Weiss, and I took this micro/macro approach to mental wellness to the next level; we competed in a pitch competition aimed at helping small organizations tackle social and environmental disparities. We pitched psychosis awareness, came in second place and walked away with a cash prize to support the rollout of our campaign.
Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?
“Be the change you want to see in the world,” is the quote I heard often and the one that most resonated with me in college. This quote inspired me and encapsulated the vision and idealism of my 20 year old self; it catapulted me into Teach For America which I pursued immediately after college and into my work with immigrant and refugee communities. Realism settled with age and with the discovery that this quote is far more than 10 words I initially heard. The full quote, attributed to Mahatma Gandhi is:
“We but mirror the world. All the tendencies present in the outer world are to be found in the world of our body. If we could change ourselves, the tendencies in the world would also change. As a man changes his own nature, so does the attitude of the world change towards him. This is the divine mystery supreme. A wonderful thing it is and the source of our happiness. We need not wait to see what others do.”
I believe that vision and change are still at the heart of this full quote but it goes deeper into the fabric of the human mind and body, both of which are at the core of the work I have come to do and love. The quote speaks to changing the world and changing the mind and body; inspiring change in the world to help heal the minds of young people and empower them to be the change they want to see.
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?
My dad’s work ethic was stellar. He was a dedicated physician and was 100% committed to his patients. After he passed away earlier this year it was astounding to me the number of former patients who reached out– patients he saw decades ago who remembered him for his compassion. My dad always told me to do my best, “As long as you do your best, you don’t have to worry”, he would say. He clearly did his best. I aspire to do the same.
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 main benefit of having a patient in front of you is the non-verbal communication that happens in the space you share. The tapping of the foot, the mismatched socks, the new nail polish. These details matter and can be indicative of mood, sleep patterns, energy level, focus. As a seasoned clinician, the impressions matter more than the words. As you see more patients, this skill gets honed.
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?
One of the main challenges that arises when a patients is not in the same space as you is that you don’t have a clear indication about where their attention lies. Is it on you and the conversation they are having with you? Or, are they disinterested in the conversation and viewing something else on their computer screen? Are they distracted by someone else in the room? Do they trust the safety of their surroundings? Can they be alone if they so choose? Even if I can guarantee confidentiality are they able to be in a safe space for this conversation?
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.)
- When your patients is not physically in front of you, it is hard to assess their physical well-being. Psychotherapy via telehealth is focused on conversation. It is rare to see more than someone’s head and therefore hard to know what is going on with the rest of their body. Have they gained weight? Are they fidgeting? Engaging in compulsive movements? All of these are important factors in the context of first episode psychosis where weight gain is common second to anti-psychotic medications and anxiety as well as obsessive compulsive disorder are common co-morbidities. I have learned to ask people to step back and allow me to see their whole body or create scenarios to assess bodily functioning, “Can I see your new shoes?”…”Can you walk over to the other side of the room and show me that game you got?”
- When a patient is not physically in front of you, it is beneficial to know where they are as this can influence what they share or do not share with you during your visit. I was recently conducting a psychotherapy session with a 17yo who was far more optimistic than usual. I was curious about what had changed for him. At the end of the session I became aware that his 10 year old brother was also in the room with him. Was my patient presenting differently because he didn’t want his brother to know about his anxiety and his delusional thoughts? Or, was his brother’s presence supportive and helping him to feel less anxious? It is important to always ask, is anyone in the room with you? Are you in a private and safe space?
- Historically, doctor’s visits and therapy sessions have been held in confidential spaces. That sacred time and space where provider and patient are alone ensures focus on one another. It is where important work happens. Therapeutic work can be compromised with distractions, for example, food deliveries (common in our pandemic life) or patients playing computer games during their sessions. I tend to address this differently with each patient, especially with adolescents where the therapeutic relationship is paramount. Playing a quick game with a patient might allow for a transition back into session. Here is another example, I see a young woman who uses her lunch break from work as our appointment time. She is typically preparing lunch or picking up food. It is not an ideal therapeutic situation BUT she is still prioritizing our work and telehealth allows for this to be possible. The current landscape supports us to meet in this way, and we both could not be more thankful.
- When a patient is not physically in front of you, it is important to discuss the telephonic and virtual worlds. Patients have opinions about speaking via phone vs. presenting on a screen. Hearing each person’s opinions and preferences is so important and crucial for maintaining rapport. I was intentional about asking and responding to preferences at the outset of the pandemic. Some people didn’t trust the Zoom platform that we were using for sessions, others didn’t want to look at themselves. I started where people were at and revisited regularly.
- When a patient is not physically in front of you it is crucial to imagine that they are. This pandemic year has posed so many challenges for care providers and patients. It is too easy for both to get distracted by phones, emails, pets etc. It is so important for me to be fully present. The distractions are equally there for me as for my patients. I totally understand and we all have to be gentle with ourselves. A great telehealth lesson that will last beyond.
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?
As stated above , Telehealth can allow one to see patients interacting with others and the outside world. It is a way to see person in the environment and to see what is important to them outside of themselves. One of my patients presents to session with her dog besides her. I heard about her dog for years prior to the pandemic, I finally got to meet him during the pandemic. This endeared me to him even further as he has been a transitional object for so many of my patient’s losses over the past few years. Recently, her dog passed. I was able to share her pain more fully and more authentically having met her dog via Telehealth.
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?
I love the share screen feature on Zoom. I am able to watch videos, illustrate concepts and take notes in real time and so are patients. One of my best share screen moments was allowing my patient to draw me a diagram of her mood fluctuations throughout her school day.
If you could design the perfect Telehealth feature or system to help your patients, what would it be?
The perfect Telehealth experience would further integrate the senses. For example, office spaces often have specific scents that resonate (or not) with patients. It would be awesome to capture and share that scent with patients to help them feel as if they are in the same room with their provider.
It would be ideal to also see a greater expanse through telehealth features. I have learned so much about patients by seeing their surroundings.
Lastly, I do wish the telehealth systems could allow for health-specific communication. I often assess patients with evidence-based objective measures. I would love to present this information back to my patients in exciting formats. Let me demonstrate your progress interactively through exciting visuals.
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?
I want all patients to know that Telehealth sessions matter just as much as in person sessions.
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?
Admittedly, I am not in the new tools loop but am excited to explore it!
Is there a part of this future vision that concerns you? Can you explain?
I am tired of staring at a screen all day, I miss sharing space with people. A 100% Telehealth world for any one patient concerns me for all the reasons listed above. A hybrid world would be much more optimal, allowing patients and providers more flexibility.
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. :-)
Accessibility is the biggest issue. The majority of patients on my panel have been fortunate enough to have access to Wi-Fi and smart phones or tablets. Not everyone at our clinic does. Wider access to the internet. Smartphones provided by healthcare providers to patients. Telehealth stations similar to telephone booths and libraries that would have dedicated areas for private appointments.
How can our readers further follow your work online?
My clinic’s work can be followed here:
https://www.instagram.com/calmnola
https://m.facebook.com/CALMnola/
Thank you so much for the time you spent doing this interview. This was very inspirational, and we wish you continued success.
