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Year : 2020  |  Volume : 25  |  Issue : 2  |  Page : 71-75

Etiquettes of practicing telepsychiatry

Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India

Date of Submission09-Dec-2020
Date of Acceptance12-Dec-2020
Date of Web Publication23-Feb-2021

Correspondence Address:
Sandeep Grover
Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh - 160 012
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Source of Support: None, Conflict of Interest: None

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How to cite this article:
Grover S. Etiquettes of practicing telepsychiatry. J Mental Health Hum Behav 2020;25:71-5

How to cite this URL:
Grover S. Etiquettes of practicing telepsychiatry. J Mental Health Hum Behav [serial online] 2020 [cited 2022 Dec 9];25:71-5. Available from: https://www.jmhhb.org/text.asp?2020/25/2/71/310051

Etiquettes are “the set of rules or customs that control accepted behavior in a particular social situation or social groups.”[1] Simply speaking, Etiquettes are manners or good behaviors that distinguish human beings from animals'. Etiquette makes a person cultured individual; make a person leave his mark. Etiquette teaches us how to talk, walk, and most importantly, behave in society.

Etiquettes do influence the doctor–patient relationship and possibly improve the satisfaction level of the patients with the consultation.[2]

Although people have been practicing telepsychiatry for quite some time now in India, such a practice's legal status was not exact till recent times. Further, these Telepsychiatry services were organized in an office setting or were mostly limited to voice calls. During the COVID pandemic, on March 25, 2020, Government of India, issues the Telemedicine Guidelines for online consultation, which legitimized the online consultation and telemedicine consultation. Due to the lockdown and absence of transport facilities, patients and families were left to either visit the emergency services or seek teleconsultations. Both these developments provided a major boost to the Telepsychiatry services. In this context, the Telepsychiatry consultations moved from voice calls only to the video-calls and the use of various platforms to connect with their patients. In this connection, the term etiquette has been referred to as netiquettes, which is defined as a set of rules for acceptable online behavior.

Many authors have tried to define telehealth etiquette, and these include unique typical professional behaviors, which are required to conduct a significant telehealth visit or, more importantly, prevent a poor telehealth visit.[3],[4] These behaviors are beyond the usual professional actions and include nonverbal and verbal communication skills needed for successful telehealth interactions.[3],[4]

A physician's expected behaviors providing telehealth consultations can be understood under the four broad headings, i.e., preparing for the visit, beginning of the visit, conducting the visit, and wrapping up the interview.[3] During the preparation phase, the clinicians should focus on their grooming, background, place of teleconsultation, lighting and sound, type and quality of equipment, collecting the contact details of their patients, and also ensuring that the people on the other side also prepare themselves for the video-consult [Table 1].[3],[4],[5],[6] Ideally, the clinicians should also collect previous treatment records and investigations beforehand and review them before the video-consultation. This will not only help in seeking further clarification but also aid in the time-economy of the video-consultation. Good planning often helps in providing satisfactory services. Another critical aspect of preparation is being on time. Clinicians, who often do not work with an appointment, which is often the case in the outpatient services at most governmental services, clinicians often do not place much importance on punctuality, and patients often have to wait for varying durations extending up to hours in the waiting areas. However, while providing the teleconsultations, the clinicians should note that patients and their family members are at their home or workplace and have not organized their day, like a usual outpatient visit. Hence, the patients and caregivers are often multitasking the video-consultation along with their household and professional responsibilities. Hence, being punctual for the video-consultation can help both patients and the clinicians in discharging other life priorities simultaneously and improving treatment satisfaction. The punctuality should be limited to the beginning of the consultation and should be considered while wrapping up the video-consultation.
Table 1: Etiquettes for carrying out a tele-consultation[3],[4],[5],[6]

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As the clinician approaches the video-consultation, they should take care that the microphones are muted till the visit begins. At the beginning of the consultation, the clinicians should ensure that the person receiving the care is comfortably seated and is in the correct position for the camera and microphone. Efforts should be made to ensure the patient's privacy and accessibility. At the beginning of the consultation, the clinician should check with the patient about whether they can see and hear you clearly. While carrying out the video-consultation, the clinicians should keep it in mind to look at the webcam, rather than look at the screen, speak slowly, clearly, and pause for potential lags in the transmission, in a normal voice and use natural gestures while speaking. It is vital to maintain a smile, and the clinician should avoid yawning or chewing gum, or eating while carrying out the teleconsultation. Throughout the interview, clinicians should maintain proper eye contact, keep on nodding the are and lean forward, and enhance the therapeutic alliance. The clinicians should also encourage the patient and others involved in the teleconsultation to speak clearly and directly into the microphone in a normal tone and ensure that only one person says at a time. During the teleconsultation, clinicians should be aware of their habits and avoid interrupting the patients and others while speaking, themselves use respectful language and monopolize the conversation.[3],[4],[5],[6]

At the beginning of the teleconsultation, the first step should involve clinicians introducing themselves and others involved in the visit and obtain permission/consent to conduct the teleconsultation. Although some of the authors suggest that if the patient starts the consult, the consent is implied, but this should not be presumed, and efforts must be made to obtain explicit consent. The initial few queries should involve understanding the patient's location, knowing about the people around, and if required, getting introduced to them. If there are other people present in the same room as the patient, the clinicians should ask the patient whether they are comfortable in talking in the presence of others, or prefer to talk alone. The patient request for privacy should be respected. However, suppose the patient lacks capacity and/or is suicidal. In that case, the judgment should be based on the risk assessment and possibility of participation in the interview, in the absence of others in the room.[3],[4],[5],[6]

Suppose the clinician wants to record the session. In that case, it is important to obtain separate consent for the same by informing the patient and others involved about the purpose of the recording uses of the recording in the future. It is essential to educate the patient that they have the right to refuse at the beginning of the interview and if they desire, they can also ask the clinician to interrupt the recording during any part of the interview. At the beginning of the interview, the clinician should tell the patient that they can ask the clinician to repeat the questions if anything is not clear to them.[3],[4],[5],[6]

If the clinician is interested in taking notes or review the records during the teleconsultation, they should inform the patient that they are listening and documenting the ongoing discussion. As not informing the patient and others involved may convey a message that they are being ignored, and this can be counterproductive to the therapeutic alliance.[3],[4],[5],[6]

At times, senior clinicians may be involved in supervising their colleague's clinical work while carrying out the teleconsultation. In such a scenario, the clinicians should maintain a congenial environment. If the fellow colleagues have missed out on anything clinically important information, they should refrain from shouting at their fellow colleagues. At the same time, the patient is connected, as this may be demeaning and could lead to disruption of the therapeutic alliance and respect for the colleague in the eyes of the patients. On the other hand, when the trainees are participating in the tele-interview, maybe as an observer of the interaction between the senior colleague and the patient, the trainee should appear attentive, rather than disinterested.

As pointed out earlier, the clinicians should carry out the tele-consultation at a place where there are no distractions. In similar lines, the clinicians should avoid multitasking while providing video-consultation, including answering to phone calls and E-mails.[3],[4],[5],[6]

Once the clinicians have satisfactorily carried out the tele-consultation, they should prepare themselves for closing the interview properly to improve the satisfaction with the teleconsultation. By the end of the interview, the clinicians should have clear instruction for the patient and others involved in the tele-consultation, including informing the patient about the diagnosis, need for the investigations and how the prescription will be transmitted, when the patient is expected to follow-up, what to do in case of emergency in terms where to assess the health-care services, what to do in case the patient experiences suicidal behavior, etc. Before closing the interview allow the people involved in the interview to ask any questions, they may be having about the clinical encounter. Further, it is always a good idea to seek feedback from the participants with the teleconsultation, which can improve the services.[3],[4],[5],[6]

The most important aspect of teleconsultation to be kept in mind is being professional in the encounter. One of the most important aspects of this is being professional in terms of being available for the teleconsultation few minutes before the scheduled time and should end the teleconsultation on time.[3],[4],[5],[6]

  References Top

Cambridge Academic Content Dictionary©. Cambridge University Press.  Back to cited text no. 1
Ong LM, de Haes JC, Hoos AM, Lammes FB. Doctor-patient communication: A review of the literature. Soc Sci Med 1995;40:903-18.  Back to cited text no. 2
Haney T, Kott K, Fowler C. Telehealth etiquette in home healthcare: The key to a successful visit. Home Health Care 2015;33:254-9.  Back to cited text no. 3
Gustin TS, Kott K, Rutledge C. Telehealth etiquette training: A guideline for preparing inter-professional teams for successful encounters. Nurse Educ 2020;45:88-92.  Back to cited text no. 4
American Telemedicine Association. Concise Guide for Telemedicine Practitioners: Human Factors Quick Guide Eye Contact [PDF]. American Telemedicine Association; 2016. Available from: https://hthu.net/site/wp-content/uploads/2017/07/Eye-Contact-Quick-Guide.pdf. [Last accessed on 2020 Oct 31].  Back to cited text no. 5
Professional Risk Management. Telepsychiatry Etiquette Tips. Available from: https://www.prms.com/media/2370/rm_0262-telepsychiatry-etiquette-tips.pdf.  Back to cited text no. 6


  [Table 1]


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