Expanding Patient Services Using Telehealth

In this video, W. Clay Jackson, MD, DipTh, talks about expanding medical services to patients during the COVID-19 pandemic using telehealth, including using scales and screeners during patient telehealth visits.

Additional Resources: 

  1. Singh J. How I practice now: overcoming the logistical challenges of telemedicine. Consultant360. Published online August 2020. https://www.consultant360.com/video/pulmonology/how-i-practice-now-overcoming-logistical-challenges-telemedicine 
  2. Using telehealth to care for patients during the COVID-19 pandemic. American Academy of Family Practice. Updated December 10, 2020. Accessed March 16, 2021. https://www.aafp.org/family-physician/patient-care/current-hot-topics/recent-outbreaks/covid-19/covid-19-telehealth.html 

W. Clay Jackson, MD, DipTh, is an assistant professor of clinical psychiatry and family medicine at the University of Tennessee.

TRANSCRIPT: 

Dr Clay Jackson:  Hi, guys. Clay Jackson here with Consultant360. I found that utilizing the scales and screeners with the telehealth visits is a fruitful combination for me. I like to use the PHQ‑9 to track the present symptomology, the GAD‑7 to track anxious symptomology. I like to use the MDQ or the Rapid Mood Screener, to screen for bipolar disorder.

There are different scales and screeners that you can use for disease severity, that can be helpful if you're tracking patient's symptoms, or if you're attempting to assist in making a diagnosis. I found these to be helpful with the telehealth or remote visits.

I also like to use a wellness scale. You could use a global assessment of functioning. You could use a World Health Organization‑Five, or WHO‑5 wellness scale. You could use the HERO scale developed by the doctors Jain–Rakesh and Saundra Jain.

These are all wellness scales that can be helpful. I find that looking at symptomatology, and also looking at wellness, or how well the patient is, can be extremely helpful for me. We could talk about the 4‑point grid of how patients look on that and whether they're very well and not very sick, or whether they're very sick and not very well.

Those are the intuitive quadrants and their counter two quadrants of patients who are just languishing, they're not very well or very sick. Then there are patients who are very sick, but they're very resilient.

We could talk about all of that, it's fascinating in terms of whether patients have an internal, or locus of control, or an external locus of control. Those can be important clues in terms of how patients might respond to pharmacologic treatment or nonpharmacologic treatment regarding mental illnesses.

I use these clues, that's a topic for another time, but the scales and screeners offer us, at least, a window into how patients are doing, not just in terms of how sick they are, but also in terms of how well they are, which can be extremely helpful in driving functional outcomes that patient's value so highly.

Also, increasingly we're seeing as metrics, that we are being graded on in terms of quality metrics in the healthcare marketplace. These are important for a number of reasons, chiefly, because they're important to patients.

Finally, a few words about self‑care. While we're talking about wellness for patients, we would be remiss if we didn't talk about wellness for ourselves. The pandemic has stressed all of us, and it's affected our personal lives. Most of us have a friend, or a loved one, a community member that's dear to us, that has been lost to death because of COVID‑19.

Most of us have suffered various financial, managerial, and administrative pressures, have been concerned about our practices and our patients in a new way, because this was a unique challenge to us.

It's very frustrating to know that you have skill sets that can help patients, but then not to be able to deliver those because you might not have personal protective equipment, or you might not have the clearance to bring people into your waiting room. All of these challenges for us were quite new.

It's OK to recognize that we've all been through something that's unprecedented in our careers, and it's important to take time for ourselves, to take time to talk to our colleagues, to take time to do those things that make us human beings because we, the practitioners, we are the most important therapeutic tool that our patients have.

If they don't believe in us, they won't believe in treatments. They come to us not necessarily only because of the treatments that we offer, but because they believe that we, in offering the treatments, care for them, that we have knowledge, and understand their suffering, and that we can offer something to help them with that suffering.

Let's remember to keep ourselves sharp as tools, to make sure that we're well maintained, and make sure that we take some rest and time for ourselves, and our families, and loved ones, in order that we can help our patients the best that we can do. With that, you guys, blessings, do well with your patients. Have a great day.

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