Is a telehealth consultation right for you?
Deciding to have an online (‘telehealth’) or in-person consultation can be a significant decision for some people. For others, telehealth may be the only option. Luckily, we know that both work. For those that are looking for guidance, the below list may assist with decision making.
Prior to the pandemic, telehealth consultations were available but used sparingly. The technology was weakly adopted until it was needed, used more for distant meetings rather than health consultations. Covid forced most practices to adopt some form of telehealth, as the reasons for meeting in person were weaker than the physical risk to clients and clinicians.
Since then, the option for online mental health services is considered a normal variant rather than something to be avoided. It is undeniable that in-person consultations have certain advantages over telehealth consults. But the reverse is also true. Everyone can decide for themselves. Here I explore some pros and cons of online mental health consultations.
Disadvantages to telehealth consultations
Rapport can be easier to establish in person. Few would argue that it is easier to trust someone after a sound meeting in person, rather than meeting someone over the internet. It is easier to discern body language and a shared environment can lead to better synchronicity of experience, in turn leading to improved trust.
Technology is both a blessing and a curse. Invariably, no matter how good the system, technology mishaps occur. These can be highly frustrating and cost the client and the clinician time and money and add frustration to an already resource intensive interaction.
As a clinician, it can be more difficult to understand non-verbal communication over video. Only what is visible in the screen can be visually contextualised, thereby losing some of the wider context. Clarity of picture can also reduce the small but meaningful expressions people display. This can reduce the accuracy of the assessment. In my experience, however, this is less than one might expect. I would estimate 80% of what is gained from an in-person consultation is available in a telehealth consultation.
Advantages to telehealth consultations
They are convenient. I initially thought people from rural areas would be most likely to embrace telehealth long-term, however, I’ve noted that busy professionals and families in cities also will often prefer telehealth, as they can dial into a consultation from their home or a private place at work, eliminating travel time and costs.
For a small group of people, rapport and trust is easier online. People sometimes feel safer in their home environment, and therefore express more during a consultation. Often, trips to consultation room are anxiety provoking, and therefore can inhibit rapport and trust. Having a consultation in familiar environments can assist therapeutic alliance.
As above, travel is an ever-increasing burden in big cities. It is also a significant cost for people in rural areas to travel to major centres for healthcare. In a remote area, the cost of flights and accommodation for individuals and families can run into the thousands. Telehealth removes this. All that is required is a decent internet connection and a private, well-lit space.
For consultations with adolescents and children, it is often beneficial to see the young person in their home environment. A telehealth consultation often allows more seamless discussion with parents, whilst observing younger children in the environment where they may have difficulty (for instance, the hyperactivity and social difficulties in attention deficit hyperactivity disorder).
Consultations do not normally need to be cancelled for sickness. Out of concern for patients or clinicians, most practices prefer that people do not attend consultations if they are unwell. Rescheduling can lead to additional expense, inconvenience and lost time.
The bottom line
Telehealth consultations were exponentially used during the Covid-19 pandemic. They forced clinicians and their clients/patients to adapt to a different mode of interacting. Particularly in mental health, online consultations remain an important mode of therapy, though the pros and cons must be weighed for everyone. The above list is not exhaustive but may help individuals to decide if telehealth is for them.