Dr. Ashby has been a telepsychiatrist with innovaTel for almost five years. In this interview, he sat down with Lauren Lashbrook, Director of Strategic Partnerships, to discuss his experience as a telepsychiatrist and what the transition looked like for him from running his own private practice to becoming a full-time telepsychiatrist. Just wait until you hear how he involves his pets.
Tell us a little bit about you, why did you want to pursue a specialty in child and adolescent psychiatry?
How long have you worked as a telepsychiatrist and what did you do before working with innovaTel Telepsychiatry?
Can you tell me about transition from private practice to telepsychiatry?
The decision to go full time was hard because my community, like many, is underserved and there are not enough child and adolescent psychiatrists where I live. I knew that if I closed my practice, my families would have a hard time finding services. It was very important to me to make sure that I was still serving communities that were underserved and the agreement that I made with myself was that if I was able to serve MORE families, then I would continue with telepsychiatry.
With telepsychiatry, just being able to focus on patient care, and not the administrative responsibilities of managing a practice allows me to actually see more patients. I kept track of all of those numbers the first year to keep the commitment I made to myself, I wanted to make sure I was treating more patients and making an impact and it was clear, I was.
What does a day in the life of a telepsychiatrist look like?
The nursing staff brings the patients into the room, and I watch the nurses get vitals and I watch the interaction between the nurses, kids, and families. I then go through the appointment just like I would if we were face-to-face and then if I need to talk to the parents or children individually, I will instruct them accordingly.
When the appointment wraps up, I am finishing my notes and electronically prescribing any medications and then prep for the next patient. Doing this, allows me to be much more efficient with my documentation. I’m not left doing hours of documentation in the evening like I was at night in my private practice. Because of the technology and the patient not seeing me type, I am able to document concurrently without interrupting the patient flow or breaking eye contact.
How do you collaborate with the rest of the treatment team at the facilities that you work with?
Either they will step in the room in between patients just as if I was there on site or they will send me emails throughout the day. Since I’m at my computer all day, I’m able to answer emails very quickly.
It’s the question everyone wants to know, does it feel different treating kids via technology instead of face-to-face? Do you think this impacts their treatment?
I think psychiatrists will always try to find a way to make themselves connect with their patients and their family. When I was in private practice, my fish aquarium was a big hit, my patients always wanted to see my fish and it was something else that we could chat about, it really helped break the ice.
In telepsychiatry, I don’t have a fish tank, but I do have my cat and my dog. If I have a child that is having a hard time settling down or is really shy or guarded, I will ask if they want to see my pets, and this is often a great tool. Using my pets, I know my patients and families feel connected with me and start building a relationship with me without knowing more about me than the fact that I have a cat and a dog.
How do the children and families you see feel about the technology?
Here’s a story I like to tell, the clinic I work in always has the patients fill out a patient satisfaction survey, I would still be on the screen during the survey, they would always forget that I was on screen, and I heard very positive reviews. I have heard that these patients satisfaction surveys reveal that the telepsychiatry services have a higher and more positive return response than the in-person services.
Tell us your favorite telepsychiatry story.
I have two. If you are talking about the clinic interaction, I do feel like I am a part of the team because I have been at the same clinic sites for 4 going on 5 years, even though I have never been there physically.
For my birthday one year, they brought me a cake and sang me happy birthday even though I was on screen, I blew out the candles through the screen and then they ate my cake in front of me.
From a clinical perspective, hearing patients tell me that they feel happy again or they feel like themselves again is always the best. When they come back and tell me that they are doing well in school, these are the reasons that I do what I do. It’s hard to separate the favorite cases from private practice and telepsychiatry because the care is similar and it’s focused on outcomes, whether that’s in person or through technology, to me, there is no difference.
What is one disadvantage to telepsychiatry?
I’ve been asked that question but I really struggle because I enjoy it so much. How can there be a disadvantage if I get to do the same job but get to wear pajamas and shorts to work every day?
How can mental health affect a child’s development?
An ADHD child could be very bright but is getting poor grades in school and they go untreated, this leads to behaviors and choices that could be getting them in trouble. If I can offer services, I can normalize their development, I can get them treated, excelling in school and prevents a whole cascade of negative outcomes.
What is your favorite thing about working for innovaTel Telepsychiatry?
For me, it’s the enormous level of support and relationships that I have been able to develop through innovaTel. Even though I work from home, I feel supported by the whole innovaTel team, my other physician colleagues and the clinics that they partner with.