Frequently Asked Questions from Patients

Q:  What is Telepsychiatry?

A:  Telepsychiatry is the practice of psychiatry through a secure internet connection linking the patient (in his/her own home or office) to a psychiatrist in his/her office.  The only difference is that you don't have to take time off work or time to drive to a physical office.  You may say:  "But it's impersonal.  I like to be able to shake my doctor's hand."  We ask:  "What's more important, a handshake or your time?"  Patients are seen at their convenience via the use of televideo equipment.  A television or computer monitor displays the video image and transmits audio, enabling a face-to-face consultation that occurs in real time. This technology benefits all involved in the process including patients, family members, psychiatrists and the remote facilities that provide the services. Telepsychiatry resolves geographic barriers allowing people in even the most remote places to see the highest qualified doctors.  Telepsychiatry  improves access to care for everybody everywhere.  It reduces risk (less time in traffic = less risk of auto accident, no physical contact with the therapist or doctor eliminates the risk of accusations of sexual misconduct, not having to sit in a lobby = less risk of someone you know seeing you and thus breaking your confidentiality--or in a worst-case scenario reduces risk of you being assaulted or attacked by an unstable patient in a doctor's lobby).  Telepsychiatry is also cost effective and good for the environment. 

The Triple Aims of Telepsychiatry are: 

To Improve Access

To Improve Health

To Reduce Costs

Q:  Why should I see a telepsychiatrist vs. one in a local office?

A:  The top three reasons are:  Convenience, Time savings, and Cost savings.  Our prices are not any higher than your local therapist or psychiatrist, and in fact our prices are often lower.  The goal is not to undercut your local providers.  They too can join our group and offer services through our network.  The goal is to free patients from the old-fashioned chains of driving  to appointments in heavy city traffic (or worse yet, having to spend two hours driving from a rural area to a big city where you then deal with heavy traffic), waiting in busy lobbies, taking time off work, all just to sit physically in the same room with someone who does not physically touch you but just sits and talks.  You can sit and talk from the comfort of your own home or office.  Save the world from some greenhouse gasses, save gas money, save wear and tear on your car, and save yourself a whole lot of time.  It's 2011 not 1942.  It's a high-tech world.  Use it to your advantage.

Q:  What are the advantages to seeing a telepsychiatrist?

A:  Convenience, Time savings, and Cost savings.  People often say:  "But you're not physically here if I need you."  If you're seeing a local therapist or psychiatrist in his or her office, and you have a problem, do you show up at the office, or do you call or send an email?  Most people send an email or call.  Does it take any more time to send an email or to call someone across the street than it does to call someone or send an email a mile away, a hundred miles away, a thousand miles away?  No.  It's all the same.  If you need a physical exam for significant medical reasons, you wouldn't get it from your psychiatrist or therapist in a local office anyway.  They would refer you to your primary care physician.

The vast majority of psychiatrists in private practice do not do the emergency or voluntary admitting for their local private practice patients as few private practice psychiatrists have admitting privileges or make rounds at the local inpatient psychiatric hospital.  Even a patient who is not considered a danger to self or others or to be gravely disabled but who is seeking inpatient hospitalization on a voluntary basis is admitted through the local emergency department where he/she must be medically cleared before a psychiatric hospital will agree to admit the patient.

Q:  What are the disadvantages to seeing a telepsychiatrist?

A:  You can't shake his or her hand.  But what's more important, a handshake or your time?

Q:  But my doctor usually weighs me and takes my blood pressure.

A:  Does your doctor use some special equipment that only a doctor can purchase?  No, he/she uses an electronic blood pressure device that you can purchase at any local store for under $30, and a good number of psychiatrists' offices I've seen over the years includes a $10 bathroom scale much like the one you have in your bathroom at home.  So weigh yourself and take your own blood pressure whenever you want, and keep a record over time, and provide the results to your doctor.

Q:  Will telepsychiatry replace seeing a doctor in person?

A:  No.  Telepsychiatry should not be seen as a substitute or replacement.  It should be seen as a supplemental tool.  Technology will not replace people.  But people benefit from technology.  There will always be a need for in-person interactions between patients and psychiatrists.  But patients and doctors need to have as many options in how to interact as possible.

Q:  Are your doctors employees?

A:  No.  Our doctors are Independent Contractors.

Q:  What's an Independent Contractor?

A:  An Independent Contractor is a psychiatrist or company or group of psychiatrists who is/are free-standing, independent from California Telepsychiatrists/American Telepsychiatrists and who want to provide psychiatric services via telemedicine.  The Independent Contractor contracts with California Telepsychiatrists/American Telepsychiatrists who in turn contracts with individual patients, HMOs, Managed Care Companies, County Mental Health Agencies, and other companies who have patients in need of psychiatric services.  We connect the psychiatrist with the patient.

Q:  How do you supervise your doctors or provide quality assurance?

A:  We want to know for certain that every doctor working for us is exactly who they say they are.  This is how we are able to obtain the highest quality professional liability insurance available.  And this is how we maintain our reputation of providing the best doctors possible.

Every doctor's credential is verified via phone, fax, internet, and other means.  We verify that each doctor graduated from the schools that they say they graduated from, that they finished the internship and residency and fellowship programs that they say they finished, that they are currently licensed where they say they are licensed, that their National Physician Identifier Database is clean, that they have no history of malpractice or disciplinary actions, and that every reference checks out.

The doctors sign a contract that mandates adherence to specific Standards of Practice and Evidence-Based Practice.  We also routinely survey patients regarding their satisfaction with the care they are receiving.

Q:  What kind of doctor or therapist will I see?

A:  It depends on your needs.  We have specialists in child/adolescent psychiatry, geriatric psychiatry, forensic psychiatry as well as general adult psychiatry.  Some doctors and therapists have special interest or extra training in mood disorder, anxiety, trauma, sleep, sexual dysfunction, attention/concentration, addictions, etc.  You can review our doctors' profiles and decide on who you want to see based on your specific needs and his/her specific expertise or interests.

Link to Our Doctors page

Q:  Do your doctors have malpractice insurance?

A:  Yes.  Every provider working with California Telepsychiatrists/American Telepsychiatrists is fully insured.

Q:  Why won't you bill my insurance directly?

A:  Insurance companies work very hard to not pay doctors.  The problem is that psychiatrists who bill insurance companies must provide the service and then try to get paid.  The game from insurance companies is to get their members seen and treated, and then to use every trick possible to deny payment.  So the member gets service, the insurance keeps the member's premium, and the doctor works for free.  None of us are independently wealthy, and being a psychiatrist or therapist is what we do for a living.  If we don't get paid, we can't pay our bills.  Since you are the one receiving the services, and you are the one who chose your particular insurance company, then it only makes sense for you to pay the doctor directly and then to get reimbursed from your insurance company.  As the member paying the premium, your insurance company is much more likely to reimburse you than it is to pay the doctor.

Q:  Why do I have to pay up front?

A:  Since this is what we do for a living, we need to get paid for doing our job--much in the same way you expect to be paid for each hour you work at your job.  The model in medicine has been one of receiving services and then paying for those services.  That makes sense in primary care where the fee you pay is based on the specific procedures done for you that day  which can vary from visit to visit (physical exam, blood draw, injection(s), sutures, suture removal, etc.).  However, in psychiatry and psychology, you know up front what the charge is going to be (initial psychiatric evaluation, 15 minute medication follow-up without therapy, 30 minute therapy with or without medication management, etc.).  If you pay up front to reserve the seat, much in the same way you would pay up front and reserve a seat to watch a concert, then you are more likely to show up for the appointment.  If you made the appointment in the first place, then likely you need to be seen.

Q:  Why don't you give a refund if I forget my appointment or fail to give 48 advance notice to cancel?

A:  Just like when you purchase a concert ticket, if you don't show up to the concert, you don't get a refund.  You reserved the seat, and that seat could not be sold to anyone else.  The concert goes on whether you show up or not.  If you reserve an appointment with a psychiatrist or therapist, that time cannot be sold to anyone else.  If you don't show up, the therapist or doctor is still there at the expected time.  At your job, if your boss can't find anything for you to do for an hour, do you expect to go unpaid for that hour, or do you expect to be paid anyway because you were at your post and ready to work?

Q:  Do you provide me with the necessary teleconferencing equipment?

A:  You must provide your own equipment.  Most modern laptop computers come equipped with a webcam and a microphone/speaker.   This is usually sufficient to serve in teleconferencing.  The only other thing you need is a high-speed internet connection.  It's best if you can be hooked up to the internet via an Ethernet cable.  WiFi can work in some instances, but it won't be as good a quality as you might like.

Q:  Do you provide me with the necessary teleconferencing software?

A:  Yes.  Before your appointment, you will receive a link in your email that you will click on to download the necessary software.

Q:  What kind of equipment do I need?

A:  You need a computer (the newer the better, at the very least a core-2 duo), a high-speed cable (not satellite, not G3) (though 4G and some DSL connections will work depending on how far you are from the ISP base) internet connection (minimum 2 Mb upload & 2 Mb download speed).

You need speakers and a microphone.  Most laptops have a built in microphone.  Many desktop computers do not have a microphone.  Many microphones are available at any local store or online.

The best camera and microphone/speakerphone are:

Microsoft LifeCam Cinema Web camera (approximately $50):  Link

The Phoenix Audio MT202/PCO Duet Voip Speakerphone Echo Cancellation Nose Suppression USB powered speaker/microphone (approximately $175):  Link 

It's good if you have a fax machine and/or scanner so that you can send paperwork back and forth between you and your doctor/therapist.

A  good quality scanner/software combo is the Fujitsu ScanSnap S1300 Deluxe Bundle (approximately $300):  Link

But you don't have to go out and purchase the above items.  The first meeting is free and is to make sure that the equipment you have is compatible with our systems.  At that point, you will be told if you need to do anything on your end to improve the quality of the connection.  Since this is about your health and well-being, it is important to have the best possible experience with the least amount of technical interference.

Q:  How often can I see a doctor or therapist?

A:  That is a decision that will be made jointly between you and your doctor and/or therapist.  Sessions are usually more frequent in the beginning until you are more stable, and then the sessions grow further and further apart.  The goal of a good psychotherapist is to make yourself obsolete as soon as possible.  A therapist does this by fostering, encouraging, developing independence in their clients/patients.  The goal is for you to be the best you can be on your own with good coping skills, communication skills, and social interaction skills.

Q:  What if my doctor or therapist is on vacation or sick?

A:  It can be arranged for you to see a provider who is covering for your doctor or therapist during such times.

Q:  How do I make an appointment?

A:  You can do it online or over the phone

800-377-8163

The online system gives your the most control and is the fastest. Link

Q:  How do I pay for my appointment?

A:  Online via our secure payment system.  You can use a credit card, debit card, or electronic check, or you can use your PayPal account.

Q:  Why do you use Independent Contractors instead of employees?

A:  We contract with individual patients and County agencies and Mental Health Clinics.  As such, we only get paid when there is a patient sitting in the chair.  We have designed this company to provide services to underserved populations, and by design our profit margin is very slim.  We want to provide the maximum amount of services for the lowest possible price.  Therefore, it is only possible to use Independent Contractors.

Q:  Why does it cost so much to see a doctor?

A:  Our prices are not any higher than your local therapist or psychiatrist, and in fact our prices are often lower.  The goal is not to undercut your local providers.  They too can join our group and offer services through our network.  The goal is to free patients from the old-fashioned chains of driving  to appointments in heavy city traffic (or worse yet, having to spend two hours driving from a rural area to a big city where you then deal with heavy traffic), waiting in busy lobbies, taking time off work, all just to sit physically in the same room with someone who does not physically touch you but just sits and talks.  You can sit and talk from the comfort of your own home or office.  Save the world from some greenhouse gasses, save gas money, save wear and tear on your car, and save yourself a whole lot of time.  It's 2011 not 1942.  It's a high-tech world.  Use it to your advantage. One of the Triple Aims of Telepsychiatry is to reduce costs. 

Q:  Can I get medical marijuana from your doctors?

A:  No.  As a company policy, we do not allow any of our doctors to prescribe medical marijuana to any of our patients.

Q:  What can your nursing support do for me?

A:  First of all, let me explain what a Psychiatric Certified Nurse is:

Psychiatric nurses are registered nurses who work with mentally ill and emotionally disturbed patients involved in a psychiatric treatment program. These nurses are employed in hospitals, chemical dependency facilities, crisis centers, mental health institutions and military facilities. The work of psychiatric nurses entails many specialized duties.

Assessment

o   A psychiatric nurse performs comprehensive assessments on new patients, compiling and evaluating both the medical and mental health history.  Before you see a doctor for a new evaluation, the nurse will make sure that all of the appropriate forms and consents and medical history are complete, that the patient identification and address is verified, and that the visit is appropriate (if someone is dead-set against medications and is really looking for a psychologist or therapist, the nurse will have triaged this before the intake appointment so that there is no misunderstanding. 

Care Plans

o   These nurses coordinate with the psychiatrists and primary care providers to develop care plans for each patient, describing the treatment methods and goals, including medications, therapy and other behavioral management systems.

Patient Monitoring

o   Psychiatric nurses then monitor these patients and their care plans throughout treatment, making recommendations for changes when advisable.  Patients can call a nurse with problems regarding medications, to review current meds and any recent changes in their med regimen, any new physical medicine drugs prescribed that need to be run by the psychiatrist, side effects, environmental issues that may be effecting treatment success, and to review recent labs and to organize all of this information with a nursing plan to be discussed with the psychiatrist.  It is important to utilize a psychiatric nurse to provide monitoring of patients when starting out on a new medication.  A psychiatric nurse can help you meet the practice guidelines as outlined by the American Psychiatric Association and the American Academy of Child & Adolescent Psychiatrists.

Crisis Intervention

o   Triage and crisis intervention is often one of the main duties of psychiatric nurses, and they may be asked to develop improvements to the current system as part of a team.

Liaisons

o   Psychiatric nurses are liaisons among physicians, psychiatric program directors, caregivers and other service providers.  Coordinating care between psych and primary care or other specialties.  

Q:  Do I get IT support?

A:  Yes.  We have 24/7 tech support to make sure the teleconferencing system is functioning properly, and we have existing back-up systems if needed.

Q:  What if I have an emergency?

A:  Use 911 or the nearest emergency department.  You must provide us with you primary care doctor's contact information, and are doctors are required to establish a professional relationship with each patients PCP and to ensure that the PCP is available for local physical exam or treatment if needed.  At the beginning of each session, you will be required to provide the doctor/therapist with your local telephone number, and he/she will call you on that number while watching you on camera to verify that your phone is functioning properly.  This will ensure that there is an audio backup in case the teleconferencing system goes down during the session, and it will give them a way to direct emergency services to your exact location if needed.

Q:  Why use California Telepsychiatrists/American Telepsychiatrists instead of some other telepsychiatry company?

A:  We provide rigorous screening and credentialing of every doctor/therapist.  We provide the teleconferencing software license(s), website homepage, 24/7 IT tech support, electronic medical record, electronic health record, electronic patient health record, corporate secure email, electronic prescribing, electronic lab review where available, training, scheduling, billing/collection, toll-free phone and fax, Psychiatric Certified Nursing support, administrative support, and very high quality professional liability insurance.

Most other telepsychiatry companies get a doctor to sign on, give him/her an email account, and have one person "on call" for IT support (who rarely gets back to the doctor in time to solve an in-session technical problem).  They expect the doctor to use his/her own phone/fax system, provide zero nursing support, provide little administrative support, and basically just serve as a "finder" connecting doctor and patient and then hoping for the best.

They pay the doctor as little as possible, keep as much of the fee as possible, and give the doctor and you the least amount of support possible in order to maximize their company's profits.  They want the doctor to see as many patients an hour as they can so that they can bill out as many med evaluations as possible, and there is very little concern for quality of care or continuity of care or the doctor's work satisfaction or the patient's care satisfaction.  There is a very high turn-over rate among these other telepsychiatry companies.  So you as a patient will have a very hard time obtaining that all important continuity of care.  How many times do you want to "tell your story all over again."  How many therapists and psychiatrists have you "brought up to speed" just because the psychiatrist or therapist you were seeing moved away, closed his/her practice, no longer accepted your insurance, took another job, etc.?

California Telepsychiatrists/American Telepsychiatrists is all about continuity of care and quality of care.

The goals of our company are to:

Meet the Mental Health Care needs of underserved populations;

Change public perception of mental health providers and the field of psychiatry;

Reduce the stigma of mental illness;

Increase cultural diversity and global understanding among peoples;

Increase connection between peoples;

Improve family relations;

Improve Access; Improve Health; Reduce Healthcare Costs;

Be kind to the environment by reducing the consumption of fossil fuels currently used in unnecessary travel;

Improve continuity of care-no longer does relocating mean a patient has to lose his/her doctor, and no longer does relocating mean a doctor has to give up his/her existing patients. 

Patient/Doctor Portability.

And finally: To eradicate isolation.

Our doctors stay with us over time because we take care of them and support them and because we value them as human beings and not just a method of billing for services.  There's nothing wrong with profit, but people are more important.  It's about the relationship.  Continuity of care is not just about the patient being able to see the same doctor over time, it's also about the doctor being able to follow the same patients over time.  It's much more rewarding to the doctor if he/she can watch patients grow and develop over time.

Who do you want working for you?

Q:  How do you check out your doctors to make sure they're good?

A:  Every doctor's credential is verified via phone, fax, internet, and other means.  We verify education, diplomas, degrees, certificates, licensures, and continuing medical education.  We check a total of six references (three professional and three personal).  We interview each doctor over the phone and then face-to-face.   And we make sure that they have no history of malpractice or disciplinary actions.

Q:  Can I have my doctor's cell phone number?

A:  Some but not all of our doctors provide a cell phone or pager number.  Each doctor has a toll free phone number with his/her own extension, and messages left on that extension are automatically computer translated and emailed directly to the doctor (the message includes a way to listen to the actual message if the computer translation is not good enough).

Q:  What if I have to cancel an appt?

A:  You can do so via phone, email, fax, or online.  Once an appointment is scheduled, you will be expected to pay for it before the session occurs.  If you need to cancel for any reason and you provide 48 hours advance notice of said cancellation, you will receive credit of your full original fee to apply toward a future visit.  If you do not provide at least 48 hours advance notice of cancellation, then you agree to forfeit your paid fee in the same way that you would not expect a refund for concert tickets that you purchased but failed or forgot to use.  In the same way that you deserve to be paid for each hour that you are at work, I too deserve to be paid for each hour that I am at work.  Just because a patient does not show up to an appointment does not mean that I am not at work.  If you reserve a seat but fail to show up, there is no way for me to fill that seat during your scheduled appointment time and therefore no way for me to be paid for that lost time.  Your understanding regarding this matter is appreciated.  Any cancellation of an appointment due to technical difficulties on our part will not incur a charge, and any fees paid for that time will be applied to a future replacement appointment.

Q:  Do any of your doctors have malpractice suits against them?

A:  No.  We only accept doctors with a clean record.

Q:  Can I be seen anywhere?

A:  You can be seen anywhere that has access to high speed internet.

Q:  Can I be seen when I'm on vacation?

A:  Yes.  If you need medication while on vacation, your doctor can send a prescription electronically to any pharmacy in the United States.  All states offer an out-of-state doctor the right to prescribe an emergency fill or refill of a medication for a week or two supply for an existing patient from another state who is visiting that guest state.

Q:  Can I be seen when I'm overseas?

A:  Yes.  However, if you need a medication while overseas, it is likely that the US doctor will not be able to fill a med at an overseas pharmacy.  However, the doctor could fill a med at your local pharmacy, and you could have a family member or friend pick up the medication at your local pharmacy and then express mail it to wherever you are in the world.

Q:  How does the doctor prescribe medications for me?

A:  Medications are prescribed electronically or called into the pharmacy of your choice.  Certain prescriptions do require a paper Rx and an original signature.  In such instances, the doctor will mail you the paper Rx directly to your home for you to take to your local pharmacy.

Q:  What if I need a physical exam?

A:  Our doctors are required to work closely with your primary care physician.  If you need to be examined physically, you would make an appointment with your PCP who would then communicate the results to your psychiatrist.

Q:  Why do you require that I give permission to interact with my PCP?

A:  Since our doctors work only via telemedicine, they can't do a hands-on physical exam.  So it is important to have a doctor who is near you who can perform a physical exam when needed and to also be available in emergencies.

Q:  How do your doctors keep records?

A:  Our doctors are required to keep electronic medical records (EMR) of every encounter with you on the corporate EMR system.

Q:  Can I see my medical record?

A:  There will be parts of your record that you have access to.  Clinical notes in psychiatry can sometimes be sensitive.  And so it is up to your doctor as to whether or not you can have a copy of the actual note.  If there is a concern that information in the note might be misunderstood or might cause stress or anxiety, then sometimes the doctor will spend time going through a note with you in session.  You can also request a written summary from your doctor regarding the care that has been given.

Q:  How do I communicate with my doctor or therapist, and how do they communicate with me?

A:  All of our doctors have toll free phone numbers where a non-urgent message can be left 24/7.  All of our doctors also have corporate emails where you can send secure, confidential emails directly to your doctor.  Messages can also be exchanged through our secure website where you will have a login ID and password unique to you.  Some of our doctors do give out their cell phone and/or pager information.

Q:  What teleconferencing system do you use?

A:  We use multiple systems.  All of  them are secure, encrypted systems that meet the confidentiality requirements of federal HIPAA regulations.

Q:  What kind of internet connection do I need?

A:  The faster the better.  A cable modem is best.

Q:  Is Wi-Fi okay?

A:  Generally, no.  You can get away with it sometimes, but usually there is not enough bandwidth to support ongoing Wi-Fi connection.  You usually suffer a loss in sound quality, and if there is a lot of movement in front of the camera on either end of the connection, then the system will shut down.  So it's best to have an Ethernet cable connected directly to the modem or router.

Q:  I have satellite internet, will that work?

A:  No.

Q:  What about a G3 hotspot?

A:  It will work as an emergency backup but not as a basic daily connection.  Sound will be choppy, and there will be a delay in video as well.  Audio and video will typically not be linked.  A 4G hotspot will likely work fine.

Q:  Does the therapist or doctor record me in any way?

A:  Under no circumstances will you be recorded in any way.  That is absolutely against HIPAA rules regarding confidentiality.  Any teleconferencing software provided by California Telepsychiatrists & American Telepsychiatrists will be administratively blocked for recording for all users.

Q:  Can I record the session?

A:  You must sign a contract that you will not record (audio and/or video) any session between you and your doctor.  Recording a doctor/patient interaction in any way is against the law and punishable by fine and imprisonment, and California Telepsychiatrists & American Telepsychiatrists will pursue legal action to the fullest extent of the law against any patient who records and publishes in any way any interaction between the doctor and the patient.

Q:  What are the limits of confidentiality?

A:  Confidentiality is not absolute, and there are circumstances in which information can or must be released.  These exceptions vary depending on the type of professional you work with and by state. In general, your communication is not confidential if your therapist/psychiatrist tells you that your communication is not privileged or confidential. You should not assume that your communication is confidential and you should ask if you have specific concerns.

Under certain circumstances certain information may or must be revealed or released to others. The following are examples of exceptions that may apply:

       If your therapist or counselor or psychiatrist is subpoenaed and ordered to testify in a court of law and their objections are overruled. This happens in very few instances and typically occurs in legal proceedings involving child custody, law suits in which services you received are considered to be evidence in a court of law, or charges involving certain types of criminal behavior.

       If you request that your counselor or therapist or psychiatrist communicate with someone, you will normally be asked to sign a "Release of Information" and to specify what can be communicated and for how long the release will remain in effect.

       If your therapist believes that abuse or harm has been done or may be done to a child or to an elderly or disabled person. This would involve situations where they find it is necessary to report this information to proper authorities. 

       If your therapist or counselor or psychiatrist believes that you are dangerous to yourself or another person, and it is necessary to take steps  to protect you or the safety of others.  They can only release that information that is necessary to protect or insure the health and safety of you or a person at risk.

       If during a medical emergency your therapist or counselor or psychiatrist needs to reveal information that is necessary to protect or insure your health and safety. They can only release that information necessary to protect or insure you health and safety.

       If your therapist or counselor or psychiatrist must take action to collect a debt incurred for services, your name and the amount of your debt may be revealed to a collection agent.

       If you are told that you are not a client or patient or if the professional tells you that your communication is not confidential.

       If you are a minor, or a minor that is not emancipated, a therapist or counselor or psychiatrist may be required to advise or involve your parents or guardian in your treatment.  There are circumstance in which a psychotherapist is not required to notify the parents of a minor.

If you have any questions, concerns, or confusion regarding your rights to confidentiality, or any potential exception, you should discuss this with your counselor or therapist or psychiatrist.  You will be provided with a written statement regarding our services and policies

Q:  Can I be seen in the evenings or on weekends?

A:  Many of our doctors and therapist do offer evening and weekend hours.

Q:  How do I know the doctor I'm seeing is licensed to practice in my home state?

A: In California, you may obtain information about a physician from the Medical Board of California by calling (916) 263-2382  

, option #1, or by going to "Check Your Doctor" and viewing a physician's profile. You also may want to check the Osteopathic Medical Board's Web site if you are unable to locate your physician on the California Medical Board site.

Q: Has my doctor ever been in any kind of "trouble" or had any complaints filed against him?

In California, you may check your doctor's profile on the California Medical Board Web site at "Check Your Doctor."

Complaints are confidential in California. However, disciplinary action against a licensee is public.

Q: How do I find out if my doctor has been, or is, licensed in another state?

A:  You may contact the Federation of State Medical Boards located in Euless, TX, at the toll-free number              

866-275-2267 for further information about state medical boards other than California.

Q:  How do I know the doctor I'm seeing is Board Certified?

A:  Check this link.  You have to register, but it's free.

Q:  Why do I care if my doctor is Board Certified?

A:  Expert Health Care in Medical Specialties

When you or a family member needs health care or medical treatment, you want a highly qualified doctor dedicated to providing outstanding care. When you choose a doctor who is Board Certified, you can be confident he or she meets nationally recognized standards for education, knowledge, experience and skills to provide high quality care in a specific medical specialty. Board Certification goes above and beyond basic medical licensure.

A History of High Standards

Since 1933, ABMS Member Boards have been certifying doctors, to help assure patients as well as hospitals, health plans, insurers and the government that these doctors are qualified to provide expert health care in an ever-expanding number of medical specialties and subspecialties.  With the guidance and support of ABMS, each of the24 Member Boards is responsible for developing and implementing the educational and professional standards for quality practice in a particular medical specialty or subspecialty, as well as for evaluating certification candidates.

A Lifetime of Learning

ABMS is nationally recognized for the high standards the Member Boards set to certify doctors in various medical specialties. And to make sure Board Certified doctors continuously refresh and expand their knowledge, the Member Boards have also established the ABMS Maintenance of Certification® (ABMS MOC®) program for career-long self-assessment, learning and improvement activities.

Q:  Why do I have to sign a contract?

A:  It is standard practice for a therapist/counselor/psychiatrist and a client/patient to sign a contract at the beginning of therapy.  It serves to inform and protect both you and the clinician.

Q:  Why do I have to sign a consent for treatment form?

A:  It's the law.

Q:  Why do I have to sign a consent for treatment via telemedicine form?

A:  It's the law.

Q:  Do you have Standards of Practice?

A:  Yes.  At the bottom of this page are the links to the American Telemedicine Association Telemental Health Chapter.

Q:  How do I know that the doctor or therapist I'm seeing is really who he/she says he/she is?

A:  We verify identity on all of our therapists and doctors before they sign a contract to work with us.  Their photo is placed on our website.

Link

If the person you're speaking to on the teleconference does not look like the photo of that provider on our website, please contact us immediately at 800-377-8163.

Q:  How do I file a complaint about a doctor or therapist?

A:  We strongly encourage you to address any concerns that you have regarding your treatment directly with your doctor or therapist.  If that does not give you satisfactory results, then please contact Dr. Schaeffer & California Telepsychiatrists/American Telepsychiatrists at 800-377-8163.  If you are still not able to obtain a resolution, then you file a complaint with your state's Medical Board.

In California, this is the complaint process.

Q:  How do I file a complaint about technical problems?

A:  Contact us directly at 800-377-8163.

Q:  How do I schedule an appointment?

A:  The easiest way is online directly from our website.  Each provider has a link to follow that will guide you through the appointment process.  You can also call 800-377-8163 Ext 1 to request an appointment.  Please specify which doctor or therapist you would like to see.

Q:  Do you have doctors who speak my native language?

A:  We currently have doctors who speak Chinese, French, and Spanish.  We are working on adding many more doctors, and we have a particular interest in providing patients with doctors who speak their native language.

Q:  I'm in an HMO or PPO.  Can I see my doctors or therapists listed with my HMO/PPO?

A:  Your doctor or therapist can request to be a part of our panel of providers.  Please speak to them directly and ask them to visit our website and click on "Join Our Panel of Doctors/Providers."

Q:  Is it legal to see patients this way?

A:  In California, there are prohibitions relating to prescribing over the Internet, which can result in license discipline, and carries hefty fines for prescribing without an appropriate prior examination (Business & Professions Code Section 2242 and 2242.1). This examination, however, need not be in-person, if the technology is sufficient to provide the same information to the physician if the exam had been performed face-to-face. A simple questionnaire, however, without an appropriate examination would be a violation of law, and would be a disciplinable offense.

In summary, the law governs the practice of medicine, and no matter how communication is performed, the standards are no more or less. Physicians using Telemedicine technologies to provide care to patients located in California must be licensed in California and must provide an appropriate prior exam to diagnose and/or treat the patient. Physicians practicing via telemedicine are held to the same standard of care, and retain the same responsibilities of providing informed consent (Business & Professions Code Section 2290.5), ensuring the privacy of medical information, and any other duties associated with practicing medicine.

For other states, please contact your state Medical Board.  A directory of all U.S. medical boards may be accessed at the Federation of State Medical Boards Web site Here.

Q:  Does my state require the initial visit to be physically in person?

A:  Not in California.  For your specific state, it is best to contact your state Medical Board.  A directory of all U.S. medical boards may be accessed at the Federation of State Medical Boards Web site Here.

Q:  Do you have translator services?

A:  A translator service can be arranged, but it will cost more per session.

Q:  What's the difference between a psychiatrist and a psychologist?

A:  Although the terms "psychologist" and "psychiatrist" are used interchangeably to describe qualified individuals who provide psychotherapy services, their training is quite different.

A psychiatrist is a medical doctor and a psychologist is not a doctor. Therefore the educational background is the most apparent difference between these two.

In terms of prescribing medications to patients, psychiatrists can prescribe medication while psychologists cannot prescribe medications. 

In terms of psychological testing, psychologists can administer and interpret psychological tests while psychiatrists cannot administer or interpret psychological tests.

Psychiatrists

A psychiatrist is a Medical Doctor (M.D.) or Doctor of Osteopathic Medicine (D.O.) who has graduated from a medical school. A psychiatrist's training focuses on general medicine while in medical school for 4 years.  Then there is a one-year general medicine internship. They will then go on to complete 3-4 years of residency where they will specialize in psychiatry and are trained for assessment, diagnosis, treatment (with both psychotherapy and medications if needed) and prevention of psychological problems. Psychiatrists can then sub-specialize by doing additional training (fellowship) in child and adolescent psychiatry, geriatric psychiatry, addiction psychiatry, forensic psychiatry, or consultation/liaison psychiatry. For the most part, psychiatrists now do psychiatric evaluations for the purpose of determining if an individual would be appropriate for treatment with medications. If so determined, the psychiatrist prescribes the medications and then follows the patient for medication management. Medication management includes initially following the patient closely until they are stabilized with the proper dosage (usually once every 1-2 weeks until stabilization is achieved) and then usually once every 1-3 months for maintenance.

Psychologists

A psychologist is a clinician who holds a Doctorate in Psychology (Psy.D.) or a Doctor of Philosophy in Psychology (Ph.D.) or EdD (Doctor of Education). These clinicians have spent at least 5 years of graduate work strictly studying psychology, then moving on to complete 1-2 years of internship followed by 1-2 years of supervised clinical work experience before qualifying for the right to sit for the licensing examination. A psychologist does not prescribe medication. Instead, they provide psychotherapy through their in-depth knowledge of  psychological theory, therapy, research and diagnostic testing. Psychologists also specialize in psychological testing and are the only group of clinicians trained to do so. Psychological testing require years of training that involves not only how to give the tests, but also how to score and integrate the test information with clinical interviews, background information, knowledge of personality theory, human development and research.

The title "psychologist" can only be used by someone who has completed the above training and has then passed both national and state licensing examinations. Informally, a psychologist may be referred to as a "therapist," "counselor," or "clinician." However, these are more general terms that can be used by other mental health professionals who are not formally trained and licensed psychololgists.

Summary:

Psychiatrist:  went to medical school (M.D. or D.O.); able to perform assessment, diagnosis, and treatment including psychotherapy and/or medications if needed.

Psychologist:  Ph.D., Psy.D., or EdD; able to perform assessment (including formal psychological testing), diagnosis, and treatment including psychotherapy but excluding medications.  (If medication is needed, a psychologist will refer the patient to a medical doctor--M.D. or D.O.--such as a psychiatrist or primary care doctor.)

Social Workers

Licensed Clinical Social Workers (LCSW's) hold Masters degrees.  Their training consists of typically 2 years of graduate school and 1-2 years of internship. LCSW's assess, diagnose, intervene and treat individuals, families and groups with psychosocial problems.

Mental Health Counselors

Licensed Mental Health Counselors (LMHC's) hold Masters degrees in counseling. They have completed 2 years of graduate training and 1-2  years of work experience under supervision. LMHC's provide counseling to individuals, families and groups.

Q:  What do I do if I can't hear/see a doctor or therapist on the teleconference?

A:  If you can't see the doctor, or the doctor can't see you, then you need to ask him/her to reschedule the appointment.  In most cases our provider will initiate the rescheduling process.  If you can't hear the doctor over the teleconferencing system, you can use the telephone as a means of audio communication while the video portion of the teleconference continues.

Q:  How does the doctor know I'm me?

A:  To get an intake appointment for evaluation and treatment, you must first fax us a government issued photo ID and evidence of current legal residence address.

Q:  My teledoctor won't prescribe narcotics.  What do I do?

A:  Each doctor practices within the standard or practice in the community.  It takes many years of training to understand the nuances of psychopharmacology, pharmacodynamics, and pharmacokinetics.  After a complete psychiatric evaluation, the doctor uses his/her clinical judgment and experience to decide on appropriate treatment.  That treatment may or may not include narcotics.  As a general rule, if you are a patient who needs a lot of narcotic medication (for pain control or whatever), then telepsychiatry is not for you.  It would be far too easy for drug-seeking patients to find multiple telepsychiatrists from various states to write narcotic prescriptions.  So the standard of care in the telepsychiatry community is to be very cautious about prescribing any controlled substance.

Q:  I don't want to be see a 'doc-in-the box."  How can I prevent that?

A:  Make sure the technology doesn't get in your way.  The connection between you and your doctor/therapist should be spot on.  Be the best patient you can be.  Don't focus on the technology.  Ask our doctor/therapist to follow our 'Basic Telepsychiatry Etiquette."

Q:  How do you oversee quality assurance over Independent Contractors?

A:  The contract mandates adherence to specific Standards of Practice.  We routinely survey patients regarding their satisfaction with the care they are receiving.

Q:  Can I get psychological testing?

A:  At the present time, we do not have any psychologists contracted with us.  Only psychologists can administer and interpret psychological testing.  We are in the process of recruiting psychologists.

Q:  Will you go to court for me?

A:  If you become involved in legal proceedings that require your doctor's or therapist's participation, you will be expected to pay for the professional time even if called to testify by another party. [Because of the difficulty of legal involvement, the charge is significantly higher per hour than the regular rate and would include reasonable time for preparation, travel to and from court, and attendance at any legal proceeding.]

Q:  I need disability.  How do I get it?

A:  We do not do disability evaluations of any kind.  You would need to see a local doctor who specializes in disability evaluations.

Q:  Am I a Good Candidate for Telepsychiatry?

1.  If you are actively suicidal, then telemedicine is NOT the place to start.  You need immediate and intensive care from a local provider who can monitor you closely.  If you are actively suicidal, then call 911 or go to your nearest Emergency Department for immediate evaluation and treatment.

2.  We do NOT do Disability Evaluations of any kind.

3.  We do not do Workers Comp Evaluations of any kind.

4.  In most cases, we do not prescribe narcotics (and certainly not in the first few visits).

If you need disability, Workers Comp, or narcotics, please contact your PCP or a local psychiatrist, a disability evaluator, or a Workers Comp doctor associated with your particular employer (talk to your HR department).

Q:  I need narcotics.  How do I get them?

A:  In most cases, we do not prescribe narcotics (and certainly not in the first few visits).  There are many alternatives to narcotic medications. 

Q:  I need you to make my boss, teacher, spouse, child do ____________.

A:  We are not in the business of making anybody do anything.  We are here to help you navigate through difficult times.  We may help you reach some insights into how your behavior, communication style, coping style, personality, and/or chemical imbalance contributes to the way others see and interact with you.  We may help you change your behavior, communication style, coping style, personality, and/or chemical imbalance in ways that improve your interaction with other people such as your boss, teacher, spouse, child, friend, sibling, parent, etc.

Q:  I need you to write a letter for me.

A:  We can do that.  Keep in mind that we are not a transcription service and that any letter we write will be based on our clinical assessment and judgment.  And we do charge for our time.

Q:  Why do I have to pay you to write a letter for me?

A:  This is what we do for a living.  If your boss asks you to write a letter for him/her, do you do it for free, or is it part of your job where you get paid for your time and efforts?

Q:  What do I do if I experience side effects?

A:  If the side effects are mildly annoying (such as some light stomach upset, mild headache) , contact your doctor via his/her email or toll-free phone number.

If the side effects are moderately annoying (such as significant nausea, mild diarrhea, strong headache, slight dizziness), contact your doctor via his/her email & toll-free phone number, or if you have it, call his/her cell phone number.

If the side effects are seriously concerning (such as rash, hives, shortness of breath, chest pain, irregular heartbeat, difficulty swallowing, fever, confusion, rigid/stiff muscles, ongoing vomiting/diarrhea, or change in personality), contact your primary care physician immediately or go to the nearest Emergency Department or call 911.

Q:  Can I see multiple doctors at the same time?

A:  It is best to have only one doctor prescribing your psychiatric medications (in coordination with your primary care physician) and only one person providing psychotherapy (it can be the same person doing the therapy and the medication, or it can be a psychiatrist for the meds and a therapist for the therapy).

Q:  How can I help myself?

Focus on prevention:

The best way to treat a psychiatric illness is to prevent its development in the first place.

Things you can do to help yourself stay psychologically healthy:

Stay connected.  Friends and family hold us together.  It's better to mend than to burn a bridge.  Value people first, and everything else will naturally follow.  And remember:  Love is not a license to be rude.

Sleep right.  The average human brain needs 8.1 hours sleep every night.

Stay clean.  Drugs and alcohol affect the brain and mood and interfere with medications.  Don't smoke.

Laugh a lot. 

Eat healthy foods with a good mixture and variety of fresh fruits and vegetables daily.

Make it your conscious intent to be your best, do your best, and to help others.

Think positive.

Work to live; don't live to work.

Take the time to recharge your batteries.

Participate whenever possible.  Doers are happier than watchers.

Challenge yourself a little each day.

Break routines.

Be spontaneous.

Spread random acts of kindness.

Turn off the television.

Talk to people.

Listen for real.

Q:  Do you treat ____________, _____________, ___________?

A:  We treat every form of mental illness, and we provide supportive and preventive treatments so that people do not develop mental illness or do not return to mental illness.

Q:  Can I buy _________ on your website?

A:  We currently do not sell anything on our website except doctors' and therapists' time.

Q:  Do your doctors or you get a "kickback" from the pharmacy companies for prescribing their meds?

A:  Absolutely under no circumstances do any of our doctors receive any compensation from any pharmaceutical company for prescribing any medication.  This is strictly forbidden by federal and state laws.

Q:  Why can't I just see my doctor individually?  Why do I have to go through your website?

A:  We provide the screening and credentialing, the teleconferencing software license(s), website homepage, 24/7 IT tech support, electronic medical record, electronic health record, patient health record, corporate secure email, electronic prescribing, electronic lab review where available, training, scheduling, billing/collection, toll-free phone and fax, Psychiatric Certified Nursing support, administrative support, professional liability insurance, and advertising.  It would be unfair for doctors/therapists to use us to find patients and then "steal" the patients from us.  And as a patient, you want  all of the support our organization provides.

Q:  Do your therapists and doctors talk to each other about me?

A:  Only if you sign a Release of Information form requesting them to interact.

Q:  How do I make an appointment?

A:  You can call 1-888-542-2103 (staff are available 24/7/365).

Links to the American Telemedicine Association Telemental Health Chapter: