How Do I Conduct Mental Status Examinations Through Videoconferencing?

While predominantly possible, conducting mental status examinations through videoconferencing may require more overt effort from the provider for specific aspects of one’s mental or physical health when compared to F2F interactions. For example, while affect and sensorium can be evaluated in a way similar to F2F methods, if the patient presents as sitting at the onset of the session, a provider may not get a sense of their physical mobility and gait that may come from walking the patient to the session room from a waiting area. Additionally, a provider must question the reasons for some observed potential issues, such as if the patient is speaking excessively loudly. Is this due to them having speech-volume control issues, the provider’s audio settings being miscalibrated, the patient purposefully speaking loudly due to being unaware that they do not have to for the videoconferencing, or simply the patient speaking too closely to the microphone? Adapting one’s evaluation for videoconferencing can include instructing a patient to stand and walk in front of the camera to evaluate gait and mobility, and directly asking about speech volumes with attempts to remedy if merely a technical-related issue.

Although predominantly possible, there are some aspects of one’s mental and physical status that simply cannot be easily evaluated through videoconferencing. One of the most pertinent components is the provider’s inability to smell the patient. Some providers rely on smell to identify if a patient has been using alcohol, if they have used tobacco products, or if they have exhibited poor hygiene due to their identified psychological or physical diagnoses. While creating challenges, alternative methods are possible to gather such information. For instance, related to alcohol use, providers may require that for patients to receive substance-related treatments with them, they must have a digital breathalyzer that is completed in real time on video as part of their treatment. Further, family members or friends may be able to provide collateral information regarding one’s substance use or hygiene habits, although trustworthiness may be a concern for some. Alternatively, for providers who work at locations that utilize routine tests for either physical health (e.g., eating disorder-related) or substance use, the provider could mandate that for treatment to continue, patients must be evaluated for these factors at specific times through local clinics, with findings being sent directly from the clinic to the provider. While more invasive and potentially more costly for patients, some treatments may require such approaches to effectively be implemented.

How Do I Help Patients Set Up Their Videoconferencing Process?

As there are multiple aspects of setting up a proper videoconferencing process, it can sometimes be challenging for a patient to remember everything they discussed with the provider. As such, in addition to reviewing the basics of videoconferencing services through the informed consent process and discussions, the provider can supply active coaching via phone or email. As patients may become overwhelmed with too many details, the coaching can focus on the most necessary points (i.e., need for high-definition equipment, high-speed/broadband internet, antimalware programs, a private and quiet room), with additional considerations (e.g., need to avoid specific clothing that can be distracting) being addressed at a later date or as they arise. To assist providers, please see Appendix L for a handout that can be provided to patients to help them prepare for the videoconferencing sessions.

Administrative Topics

Does My Malpractice Insurance Cover Videoconferencing Sessions?

Unfortunately, due to rapid changes in the field of telehealth coverage, there is not necessarily a simple answer. The short answer to this is that some do, and some do not. As such, it would be wise for the provider to contact their malpractice insurance to ask directly, and to gain the information in writing. However, even if a provider’s malpractice insurance covers their general videoconferencing practice, they may want to inquire if it covers their supervision of trainees who may be providing videoconferencing services, if applicable. Finally, beyond one’s general malpractice insurance, some may consider adding cyber-liability insurance. While varying by company and policy, this relatively newer type of insurance is designed to help with cyber-based security issues including data breaches, security issues, cybercrime, or hacking to help cover legal fees, damaged networks, and hardware/software issues.