Sep 9, 2020
Psychcast host Lorenzo Norris, MD, talks with Peter Yellowlees,
MBBS, MD, about the changes to clinical practice forced by the
COVID-19 pandemic and the likelihood that many of these changes are
here to stay.
Dr. Yellowlees is a professor of psychiatry and chief wellness
officer at the University of California, Davis. He has no
Norris is director of consult liaison psychiatry at George
Washington University, Washington. He has no disclosures.
- Prior to the COVID-19 pandemic, 1%-2% of psychiatric
consultations occurred on telepsychiatry modalities. During the
pandemic, however, telepsychiatry has become the norm for
psychiatric patient encounters.
- With the pandemic, the federal government relaxed many
regulations that limited the use of telehealth.
- For many, telepsychiatry is now a preferred modality, because
it confers high patient satisfaction, and many view it as more
egalitarian, convenient, and less intimidating. Some even consider
it more private, because the patient does not have to come to the
office, and they can remain in a safe personal space.
- Telepsychiatry can be used within a hybrid model, where a
patient can see the psychiatrist in person, using video, and the
modality changes based on the needs of the patient and the
- Telehealth has expanded access to care to many populations, so
the American Psychiatric Association and other professional
associations are lobbying the federal government to keep certain
telehealth regulations relaxed beyond the pandemic.
- Dr. Yellowlees sees telepsychiatry as the return of the home
visit because the tool allows the clinician to see how the patient
lives. He believes telepsychiatry fosters even more intimacy in the
clinical relationship because of the extra distances created
through the virtual space. In hybrid relationships, there are the
physical and virtual spaces. The physical space provides immediacy,
often more trust, and clear boundaries. But the virtual space is
convenient and provides a sense of physical and emotional space
between the clinician and patient – which can make it easier to
share intense emotions.
- The textbook that Dr. Yellowlees wrote with
Jay H. Shore, MD, MPH, “Telepsychiatry and Health Technologies:
A guide for mental health professionals,” includes a chapter on
clinical skills for seeing patients over video. Dr. Yellowlees
points out that trainees need instruction about the work flow and
clinical process, but most are savvy about how they should present
themselves on screen.
- Dos and don’ts: The clinical space for teleconferencing for
both the clinician and the patient must be private and secure.
Ensure that everyone in either room is introduced. The webcam
should be placed on top of the computer screen so that eye contact
- The clinician’s head should take up two-thirds of the screen.
Use picture in picture setting, so you can monitor your body
language during the session.
- The APA and other professional associations are lobbying the
federal government to keep certain telehealth regulations relaxed
beyond the pandemic. The changes would include removing the
geographic restrictions on licensing, maintaining parity of
reimbursement between telehealth and in-person visits, removing
frequency limitations on telehealth services in nursing homes and
inpatient settings, finalizing regulatory changes to the
Ryan Haight Act, and allowing prescribers to continue to
prescribe controlled substances without an initial in-person
Yellowlees P, Shore JH. Telepsychiatry
and Health Technologies: A guide for mental health
professionals (Washington: American Psychiatric Association
Physician Well-Being: Cases and Solutions (Washington: American
Psychiatric Association Publishing, 2020).
Support for Permanent Expansion of Telehealth Regulations After
COVID-19. American Psychiatric Association. 2020.
Telepsychiatry Toolkit. American Psychiatric Association
Show notes by Jacqueline Posada, MD, who is associate producer
of the Psychcast and consultation-liaison psychiatry fellow with
the Inova Fairfax Hospital/George Washington University program in
Falls Church, Va. Dr. Posada has no conflicts of
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