Can You Hear Me Now?

“I feel like a little girl at Christmas!” my almost eighty-five year old mother said, from an appropriate social distance, after she received her new iPad earlier this month.
My middle daughter, ever the organizer and planner, asked if her grandmother knew how to FaceTime or otherwise communicate by video in this new world of COVID-19 and social distancing. Her great-granddaughter is growing up in Colorado and she, like the rest of us, has not been able to see the little one, or any of her other great grandkids, for some time now. Something needed to be done to remedy that. My daughter had the marvelous idea that we should get her Grandma an iPad and teach her how to use it. I agreed and ordered one right away.
The look on her face when I saw my mother talking to me by video on the tablet was simply priceless. She quickly learned how to use this wonderful little piece of tech, and connected swiftly with her grandchildren and great grandchildren in Denver and Chattanooga. Something so simple lead to almost immediate joy. A silver lining in this dark gray Coronavirus cloud for sure.
We have found that we can all stay connected pretty easily to friends and family in this time of social connection crisis, but what about connections between patients and providers? What do you do when you have physical symptoms and have been told to stay away from doctors’ offices and emergency rooms? What happens when your depression deepens, your anxiety flares and the voices that were under pretty good control start to scream at you again? What happens when your resolve to stay sober is dashed by the fact that AA meetings are not meeting at all? How do you connect when mental health centers, doctors’ offices and clinics are not seeing people physically due to the worry about coronavirus transmission?
We have found that there are several very good apps and services that help us to do just that. Most of us in the local mental health center world are now working from home the majority of the time but we still have full schedules of people to assess, check for medications, and to do counseling sessions with. I thought I would share some generalities and specifics of this new world with you. It might help as you pursue your own mental health treatment, and you might find that it also goes for other medical care that you might receive as we navigate this new normal.
We communicate with you by phone call or by video calls of several kinds. This is a wonderful addition to our therapeutic arsenal, but it does come with some caveats. First and foremost, you must understand that while these ways of communicating with your doctor or therapist are quite private and secure, they may not be considered 100% HIPAA compliant. As you might remember, one of the primary jobs of the Health Insurance Portability and Accountability Act of 1996 is to safeguard your private personal and healthcare related information. Speaking with me in my office with the door closed and no one else around is about as safe as we can make things. Talking to me on our iPhones via FaceTime not so much, though it is a wonderfully vivid way to see and talk with each other in real time. You see the tradeoff there.
What are some of the other options for communicating in this new way that are being used by the local mental health community? Doxy.me is a video or audio telemedicine platform that is free to use, though it does have a paid tier with a little more functionality. I can send you a link that allows you to be in my “waiting room” until I call you for the session, which can be video or audio only. This service works well but the quality seems to be a little spotty at times, with freezes and restarts and other issues. If you have a Google or Android phone and have Google Duo, I have found that both the audio and video quality with that app are quite good. Google Voice is my go to for regular phone calls, as the connection is usually quite good and the quality of the call is quite nice as well. I have already mentioned FaceTime above, and some folks specifically asked to be contacted via that platform since they have an iPhone and trust it to be secure.
When we see you using these apps and services, we make sure that we tell you why we are doing this, that it is not the same as being seen in the office and that you give us permission to speak with you using these platforms. Most everyone I have seen over the last two or three weeks has been completely fine with these new ways of having a mental health visit. Some of the upsides? Patients do not have to waste time, gas money or effort getting to the clinic from their homes, paramount during this time of social distancing. When I call and you answer, we can get right to the point, cutting out much of the time walking to and from the waiting room, gathering paperwork for labs, etc (I can do most all of that electronically, as well as electronically prescribing most of your medication right from my laptop keyboard as well) and actually finishing many of these sessions in less time than at the center in person.
Lastly, may I leave you with some tips to help make this a smooth process on both ends of the phone screen? Understand that video or phone appointments are still appointments. They are set at specific times, and we expect to “see” you at those times. These are not casual or social calls. That means that you should be set up and ready to receive the call at the time specified, so that everyone may be seen on time for that day. I have called some patients this week, only to have a parent roust them from bed to speak with me, or having to wait for them to complete a task in the kitchen or bathroom before they can come to the phone. Consider your surroundings, as I do. I have had virtual tours of many backyards and decks, and met several cats and dogs on screen this week, which is certainly fun but may make it harder for us to really hear each other well enough to get our business together completed. Find a quiet, private spot for us to talk, just as we would if we were in the mental health center. One more thing. Remember to dress like you are going to talk to your doctor or counselor. I have been quite surprised and frankly startled a couple of times these last few weeks by what folks will wear while FaceTiming on the phone.
We are very unlucky in that we are all living through the first world pandemic in the last one hundred years. We are also quite fortunate to have at our disposal some of the most useful, easy to master technological tools for communication in our history. I am so glad that we still get to carry our work forward, maintaining our mental health even as we strive to stay physically healthy in these challenging times. Stay safe and thanks as always for reading.

Say Whaaaaaaat?

One of my colleagues was talking in a board meeting about his interactions with state legislators.  

“I’ve had several very nice telephone conversations with them. Heck, I’ve even run into one of them at Publix!”

He was very positive about the availability of the politicians and their willingness to talk, but not so much about the actions that came after the conversations. 

“They always seem to be very attentive to the fact that local issues need to be addressed at the state level, but when it comes to voting time…” 

In this season of presidential primaries and soon the general election cycle, we often see this disconnect. 

Politicians  are a very socially present and media-focused example of Everyman. 

No matter the nationality or the political party or the particular leaning towards one issue or another, they have one thing in common. They use political speak to interact with the world. 

Have you noticed these things?

They never, and I mean never, answer the question directly. 

They are constantly making promises that they must know, and we must know, they can never keep. 

As my coworker alluded to, they often say one thing in conversation but do another entirely different thing when voting time comes and the rubber meets the road. 

And Lord, don’t they say what they think we want to hear! After all, one does not get elected by saying unpopular things, promising nothing, and caring about no one. 

As we have most clearly seen in the past week, when contentious issues finally hit the House or Senate floor, politicians are hard pressed not to vote the way their benefactors want them to vote. Notice I did not say constituents. I said benefactors. 

Votes, therefore laws, come out of the pursuit of tangible and recurring support, not from conscience, personal conviction, personal values, or the expressed will of the constituents. 

Now, before you think that I am writing this morning just to bash politicians (I am not) or that this is a political blog (it is not), let me ask you this. 

Do we not do exactly the same thing with our coworkers, friends, and family? How so? 

We are often not honest in our communications. This may be purposeful, or it may be purely unconsciously motivated. 

We think one thing silently and say another aloud or in public. 

We sugar coat things, thinking that we are saving someone from the awful, raw, hurtful, powerful truth. 

We do not hit problems head on, but dance around them, avoiding them, pushing them away, or even ignoring them. 

We do not see reality for what it is. We see things the way we wish they were, but sometimes that is so far from the truth it’s not even close. 

We are people pleasers in the worst possible way. We say things not out of love or caring, but out of our own agendas. 

We say things that we think will protect the feelings of another, all the while robbing them of that most pleasant human experience, honest communication. 

We trot out our public persona in the modern day digital public square, gilded and regal and opulent and grand, knowing in our hearts that the emperor has no clothes. 

What to do? How to correct this terrible miscommunication and the conscious or unconscious need to say one thing but mean or do another?

Again, lest you think I am being frivolous and trite, this is not easy. It is hard, strenuous, emotionally dangerous work. It is sometimes painful. It sometimes requires apologies, backtracking, redaction and conciliation. 

Try your best to be honest. Simple. Fresh. Extremely difficult to do when honesty is not mainstream, popular, or in your own best interest. 

Answer the question. I don’t give a rat’s ass about your ability to be glib. Answer the damned question. 

Say what you really think and feel, not what you think they want to hear. Believe me, I know how hard this is. I’ve been writing for decades. Blogging for  years. There are many people who like to read what I write and that agree with me. There are others that think I’m an idiot. That’s not my problem. If if have something to say, I write it. 

Say no. Say no. Just say no. 

That being said, say yes! More often, in more places, to more things. (Read Shonda Rhimes wonderful book Year of Yes)

Strive very hard to communicate, not just to talk. 

Strive very hard to understand first, then to be understood. 

Hit Me Up

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How do you like to be contacted? How do you contact someone else when you need to speak with them or pass along information that you think they need to have?

We live in an information age, and we have a plethora of choices when it comes to connecting with others. We can write letters. (Remember those?) We can send postcards from the edge. We can still send telegrams. Telegrams! (STOP) We can still fax documents. 

We can use instant messaging, direct messaging, email or texting. 

We can FaceTime or Skype. 

With these methods, we contact each other dozens, hundreds, even thousands of times each month

As a doctor in the mental health field, I have mixed feelings about all these direct messages, texts, emails and IMs. I love my technology, God knows I do, and I am one of us who uses my tech toys and tools hundreds of times each day. I keep up with family and friends, write posts to my blog, look at pictures, check the weather, read books, listen to podcasts and music, and watch videos. 

When it comes to my patients, however, I can see myself holding on to the more traditional forms of communication. Why the schism? 

With tech talk, I can hear (or see) what you say, but now how you say it. Let’s face it, psychiatry is a specialty of nuances. Your body language, tone of voice and even your breathing pattern can tell me a lot about what’s going on with you when you tell me that story or ask me that question. 

Face to face time tends to be equated with caring. Which had you rather hear when you are really ill: “Come on in this afternoon and we’ll see you”, or “I’ll have someone get back with you by phone before the end of the day”?

Rapid fire exchanges tend to lead to rapid fire decisions, not always the best thing. If I am being pressured by a nurse to answer an email she sent me yesterday about a medication change for a patient, I might not research my options as thoroughly as I otherwise might have. The nurse and the patient are focused on the rapidity of my response, not necessarily its content.

Missed, or mixed, messages, might never be seen, or seen too late. The worst case scenario, of course, would be an email or text or other communication about suicidal ideation that gets misfiled, deleted or parked for days without being seen. The patient might be reaching out for all the right reasons but never be heard. The results could obviously be disastrous. 

Privacy concerns are in the news. I mean, really. Who sees what you send? Who is in the loop? Who needs to know? 

It’s a new world with instant access, rapid fire conversations and the exchange of billions of thoughts every day.

What do you think about modern day methods of communication and health care?