Episode 08: Canadian Virtual Mental Health Care: Perspectives from Lived Experience, Psychiatrist and Researcher
Dr. Sagar Parikh: Hello everyone. I’m Sagar Parikh. I’m a psychiatrist and I am your host for the CAN-BIND podcast. We have a very exciting podcast today. And just to tell you a little bit and remind you, CAN-BIND is Canada’s leading alliance of depression researchers representing more than a dozen universities and more than a dozen healthcare institutions.
Today’s CAN-BIND presentation is going to be a discussion about something that has happened that is truly transformative in healthcare. And no, I’m not just talking about COVID but yes, COVID was the generator of this and that is the transition in care from face-to-face visits to virtual care or online care where you don’t just talk to your healthcare provider face to face but you can talk to them through video, Zoom, FaceTime or some other kind of electronic means.
And to help us understand just how this transformation has happened and how well it’s working, we have a really impressive panel here. We have three individuals who have experience with this transformation from a variety of perspectives. So one individual is a person with lived experience who’s previously had face-to-face care and now is dealing with virtual care. Another individual is a psychiatrist who’s now largely delivering her care through the tube. And finally, we have a researcher who’s going to give us the big picture of what patients, clinicians alike think across Canada about this transition to virtual care.
So I’m going to introduce my panel now. So I’m going to begin with Graham. Graham is a young man with lived experience of mood disorders. Tell us a little bit about yourself, Graham.
Graham: I’m currently a student. I live in Ottawa. I go to Carleton University, majoring in Psychology with a minor in Philosophy. I’m quite passionate about mental health that’s why I’m really grateful to be here. As mentioned, I do have lived experience. About three years ago, I was diagnosed officially with bipolar 1. Before that, I was misdiagnosed a couple of times but I’m grateful to now be in recovery. I think I’ve been in recovery for about two years now so I’m doing quite well.
Dr. Sagar Parikh: Thanks, Graham and hello out there in Ottawa.
So I’d like to welcome now, Dr. Amy Gajaria who is a psychiatrist in Toronto. Dr. Gajaria, tell us a little bit about yourself.
Dr. Amy Gajaria: Hello. I’m happy to be here. So I’m a child and adolescent psychiatrist. I work primarily with adolescents and people in their 20s who are experiencing mental health difficulties. I work pretty often with racialized populations. I do some outreach in Northern Canada and to other parts of the city of Toronto and I’m also a clinician-scientist with an interest in health equity.
Dr. Sagar Parikh: Thank you, Dr. Gajaria. Well, pulling it all together, hopefully, we’ll get some interesting insights from Ms. Amanda Ceniti. Amanda, tell us about yourself and where you’re situated.
Amanda Ceniti: Sure. So I’m Amanda. I’m finishing up my Ph.D. with the Institute of Medical Science at the University of Toronto and I’m affiliated with CAN-BIND as well as the Arthur Sommer Rotenberg Suicide and Depression Studies Program at St. Michael’s Hospital working with Dr. Sidney Kennedy. And my main research area focuses on the links between concussion, depression, and suicide risk but what’s relevant to this discussion today is that we recently completed a national study looking at people’s experiences with remote mental health care during COVID, so from both the healthcare user perspective and the provider perspective. So happy to be here.
Dr. Sagar Parikh: Thanks, Amanda. So, Graham, my understanding is that you’ve seen doctors in the past for healthcare visits specifically for mental health care visits. When did you have to make the transition to virtual care?
Graham: So just a little bit of context, I believe I first started seeing psychiatrists when I was about 16 because that’s when I was starting to have some struggles with my mental health. And so from 16 to probably about 19, 20, that’s when I made the transition to online and I got affiliated or acquainted with my doctor now, Dr. Rosenblat and he’s at the Toronto Western Hospital. So I’ve been seeing him online for about two years, I’d say. I did see him in person at CRTCE, the Ketamine Clinic but now I’ve been seeing him consistently online for about two years.
Dr. Sagar Parikh: All right. And so you had the experience pre and post, pre-COVID in-person, post, online. What’s been some of the changes that you’ve had to deal with?
Graham: So it’s an interesting transition from going into person and then online. One of the things I wanted to mention was I feel like trust is a huge component that’s important when dealing with a psychiatrist or any professional in general and I don’t think if I — Because I saw, I met Dr. Rosenblat several times in person in Toronto and I already kind of got an idea of who he was. We developed that trust. But if I was to have never met him in person to begin with, I think I might have a harder time, developing that trust with him. And like I said, over the computer, it feels a lot more distant. So that’s one of the biggest transitions/differences, I’d say, between the two.
Dr. Sagar Parikh: So you mentioned two things that really struck me is important. One is in any kind of healthcare interaction but maybe more so for mental health trust is really at the heart of it, you know. You want to be open and honest with someone and you want to know where they’re coming from. And, and so here you are. You did know somebody. You had worked with them face to face and then you made the transition. And yet, I heard that it still, it still felt distant. So you actually noticed a difference between seeing the same person that you knew, seeing them online, it was different?
Graham: Yeah. So I guess the best way I could put it is it seems a lot less emotionally involved over the computer. So I think I’m actually more able to be vulnerable over the computer because I’m not sitting face to face with someone where I can also see their emotions conveyed appropriately. So I don’t really have as hard of a time telling my doctor what I might be dealing with. Where when I’m in person, there might be some issues with, to do, maybe to do with being embarrassed or being ashamed about something. So over the computer, it kind of mitigates that, if you will.
Dr. Sagar Parikh: I’m going to reach out to Dr. Gajaria now and say, you know, you’ve heard Graham and you’ve had your own experience both as a treatment provider and with individual patients of your own. Has it been remote for you as well to connect with people? And what about these issues of trust? Do you trust your patients?
Dr. Amy Gajaria: I think Graham brings up a really important point and that’s something that I hear from a lot of my patients because I work with young people who are quite vulnerable and don’t have a lot of trust in the health system. And so I was worried about this idea of trying to engage underserved youth who I’ve never met through the screen. It’s gone better than expected I think and because now I can offer a blended model. So because of the patients that I work with, we’ve always offered a blended in-person and virtual model. And I think there are benefits to that. If someone wants to come meet me and say hello to me, then they can come in person and we can sort of meet once and then kind of do a blended model because a lot of people say they do kind of want to meet you and know what you’re about and know that you know their issues and know their struggles and it makes them feel a bit more comfortable. I think they also really enjoy the idea that they don’t have to travel as much so I think people like having the flexibility. They get to meet you once and trust you but then they also don’t have to come in every single time which I also enjoy.
I find the challenges can sometimes be when people are struggling with things, with change that they’re not sort of ready to make changes or they’re still engaging in, particularly I think people are struggling with their eating. You sometimes only see shoulder up and so if someone’s not being forthcoming with you about how much they’re eating or that they’re struggling with their body image, sometimes that’s been harder to pick up virtually. And I think also sometimes the fear of the clinician is, I think it’s the benefit for the patient, they have the power just to turn off the camera or the computer and be not be within your control. And sometimes, I really value that for patients. And then also for me, sometimes, you’re working with someone that’s in a bit of a more difficult place, that can be a bit of a stress as a clinician. So I wouldn’t say it’s not so much about trusting patients but about saying people are going through different things. It depends where they’re at and sometimes there are some challenges that come up.
Dr. Sagar Parikh: Well, you’ve identified many different dimensions in which virtual care has affected the relationship and maybe can make a difference in how care is actually delivered. You know, Graham and Amy, you’ve both shared your individual perspectives. I want to pull back a little bit and see what Canadians as a whole have been experiencing. Amanda, can you tell us a little bit about what you did and what you found?
Amanda: Absolutely. So as you mentioned, we just finished this national survey of user and provider perspectives on remote mental health care. So we surveyed over 300 mental healthcare users and over 100 mental healthcare providers just to see, you know, we know that this transition has happened and people have really rapidly had to switch from in-person to remote care. But how is that actually going? How are people faring with the transition? What do they like? What do they not like? What would they suggest for improvements moving forward?
And overall, we found that the majority of people across groups, healthcare users and providers, were satisfied with remote care. So about 60% of people said they were satisfied overall. Roughly half of people used video like Zoom or OTN and the rest of the people used just telephones so audio only and there’s a lot more in the paper. But just some highlights of what we found kind of piggybacking on what Graham and Dr. Gajaria said, visual cues and body language were really helpful. Using video was really highly rated and it was actually significantly associated with remote care satisfaction. People really liked being able to see body language, non-verbal cues with video.
A lot of healthcare users reported the convenience as Dr. Gajaria mentioned of remote care being able to attend visits from the comfort of their own home. And interestingly, similar things came up to what Graham and Dr. Gajaria mentioned in terms of that feeling of comfort from home. So a quote actually from one of the participants, they mentioned that “one degree of separation” between themselves and their provider actually allowed them to talk about more vulnerable things that they had struggled to address when they saw their provider in person. So that I thought was quite interesting.
And also building on what Graham mentioned, having an existing rapport with their provider was found to be helpful. So some individuals said that if they’d seen their provider first in person and then switched online, it was a lot easier to make that switch versus if they were starting a whole new therapeutic relationship over the screen, it was a little bit harder.
Dr. Sagar Parikh: Thanks, Amanda. You’ve really covered the ground there. And I detect one common theme that all three of you made and you used slightly different words; Amy said blended care, you know, a blend of in-person and live. And Amanda, you know, you’ve said that in the survey as a whole people really had hoped that they had an initial encounter first with the individual and then, continued on through virtual care. And Graham, you mentioned that you were much more comfortable having met your current doctor in person then transitioning.
But Amanda, you’ve mentioned a few other things. But Graham, what do you think if, you know, if it had been by phone, how do you think your care visits would be? Could you imagine just talking to your doctor over the phone instead of through some Zoom or FaceTime or some other platform like that?
Graham: So it’s interesting. I actually have spoken to my doctor over the phone when we were having issues with connectivity over like OTN or something and I think if I was just to see him over the phone, I’d be losing a lot of the beneficial aspects because It’s even harder over the computer but you can’t see hand gestures, you can’t see expressions. It’s harder to read someone. I just think it would feel even more distant than it is already through the computer with that, in that respect
Dr. Sagar Parikh: So Amy, you know, I think probably you have the largest experience of directly working with individuals and you probably imagined you’ve seen some individuals for their visit online, is that correct?
Dr. Amy Gajaria: That’s correct.
Dr. Sagar Parikh: So what’s it like for you when you haven’t met the person face to face, what’s it like for you to just start off with somebody cold like that?
Dr. Amy Gajaria: I think one of the benefits of working with young people is young people are quite comfortable with technology. So there is an element of trust but there’s also some comfort in talking to folks and meeting people virtually and online. I’ve been surprised that we can create some rapport with people through video. I do insist that all initial appointments are video because I don’t feel comfortable without knowing somebody and know what they look like and kind of what’s going on with their facial expressions. But I’ve actually been pleasantly surprised of the ability to develop rapport, at least from my perspective, with initial virtual appointments in a Toronto context. I know we might speak later about working in other settings where we’re not living. For example, when I do things to Northern Ontario or Northern Canada, I think that’s a bit of a different question. But within the same geographic context, I’ve been surprised that it has gone well.
Dr. Sagar Parikh: And have you had to do any assessments or just follow-up visits by phone alone? And what’s that been like for you?
Dr. Amy Gajaria: Yeah. So I do have my rule is that the initial appointment has to be a video or in-person just because I feel that’s the most accurate way of doing it but I’ve done lots of followups by phone especially if they’re quick medication checks or some young people as we’ve talked about today have found a greater facility in speaking up what’s emotionally difficult by phone and really find there’s comfort in that especially if you already know each other well. So we try to be quite flexible with people and kind of meet them where there at and sometimes phone is really great and it helps people feel more comfortable. I do have rules about not being in a moving vehicle, not being at the mall, and things like that which have come up quite often. But we bring it up once and then we just talk about the importance of being in a private space and focusing. And again, if you do already know someone and you have the visual and it’s not exclusively what you’re doing, there’ve been some real benefits to phone, especially in folks that don’t have as reliable internet connection, aren’t stably housed. It’s been really, really beneficial for those folks.
Dr. Sagar Parikh: So Amanda, you know, we actually did a survey here. I’m a psychiatrist at the University of Michigan in Ann Arbor and we also made a radical flip to online care once COVID hit. So we did a survey and one of the questions we asked of our staff was, what was your impression of online care before COVID hit and what’s your impression now, now that you had to actually do that? And we found that, you know, attitudes were highly skeptical and largely negative before COVID hit and many people were pleasantly surprised that this could actually work. I’m wondering if your survey tried to delve into that. Like did people’s attitudes change or did they have some degree of surprise about how well it did work?
Amanda: That’s a really interesting point. We didn’t look at attitude shifts per se but we did ask people about whether they had used remote care previously, pre-pandemic and kind of the change and willingness to use it post-pandemic. So pre-pandemic, it was about one in six healthcare users and just over half of providers who would use remote care pre-pandemic. And then when we asked people, okay, how likely would you be to use remote care following the pandemic when hopefully presumably there would be no, you know, distancing restrictions or anything like that, the majority of people in both groups actually said that they would be likely to use remote care again post-pandemic. So that to me suggests that there is some kind of a shift in how people are viewing this because maybe they’ve had to use it as a requirement during this period but it’s interesting that this might actually be around to stay going forward because people seemed to be, they seemed to have changed their views a little bit in terms of their willingness to use it post.
Dr. Sagar Parikh: One of the interesting things about mental health care is that all sorts of other people like to weigh in on what’s happening and by that I mean, family and friends are always curious. Oh, did you talk to your therapist today and what did they say? And oh, they put you on a medication. Are you sure you want to take the pill for your health and all that? So I’m wondering in that spirit of, you know, nosey people, I mean, these are your friends and family maybe but still, did they say anything? Were people skeptical? What, you’re talking to your doctor online? That sounds like a bad idea. Or were they just curious how it was going?
Graham: I think for the most part they were just curious. I don’t think they have had any concerns. I’m quite open with all my family and friends about my mental health and I keep that open dialogue. I guess this is somewhat relevant but my mother is also a psychotherapist so she has been seeing clients over the computer as well for about two years too. So she’s well acquainted with how that works as well.
Dr. Sagar Parikh: All right. Well, I didn’t know your mother was a psychotherapist and so you do have a deeper insight into the challenges and benefits of online care. One of the major healthcare challenges that, all countries face but I would say Canada faces in particular is access to care and especially access to care if you live in a rural area. I was actually a rural general practitioner for a few years before I became a psychiatrist so I got to live that experience as a physician in Northern Manitoba. And I also knew when I relocated for most of my career in Toronto that people from Northern Ontario had a great deal of difficulty accessing care. Amy, you have worked in Northern Ontario. Can you tell us a little bit about what blend you’ve done of like in-person visits versus virtual care?
Dr. Amy Gajaria: Yeah. So I have done a variety of care models for Northern Canada. So I’ve done exclusively telemedicine to communities in the north when I was doing some of my rotations and residency. I have locumed and provided care within North Bay. But then also when you’re in North Bay, you will also do telephone support to the sort of more remote hospitals around there and that was pre-pandemic. That was like kind of virtual care support that we used to do. And then I’ve worked at Iqaluit, Nunavut and throughout the Territory of Nunavut for a number of years now and that has been prior to the pandemic, it was all in person and with the pandemic, we’ve done a little bit of blend of in-person and virtual.
And then also, the patient population that I’ve worked with in Toronto, as much as we think of Toronto as a small place, the patients I’ve worked with in Toronto historically have not have had great access to mental health care. They lived in parts of the city that don’t have great public transit. A lot of the patients that I see are young parents and it’s very hard to navigate public transit from Northwest Toronto to CAMH with a stroller. It takes over two hours and it’s really hard for people to access care.
So for all of those populations, virtual care has been really helpful. I would say when the cultural context is quite different, particularly with indigenous populations with Inuit on Baffin Island where I work commonly, I think it would be hard to go in there as a person who lives in the south and just do virtual care without ever having been there, developed a real understanding of the community, met people in-person because there’s again so much mistrust and so much cultural difference that I think a truly virtual model doesn’t work. You have to pair that with in-person visits and understanding and building trust.
Dr. Sagar Parikh: So Amanda, did your survey or your other research delve into issues around access and, you know, how important virtual care was to providing access?
Amanda: Yeah. I mean, our survey unfortunately didn’t capture the full extent of those issues. It was an online survey so that sort of presents its own limitations in terms of generalizability for folks who would have access to complete the survey may also have more reliable internet access to engage in remote care. Technology accessibility was something that came up in the provider survey when we asked folks about what barriers may exist in terms of providing remote care or things that could make it better. One common theme that came up in the free text responses was kind of facilitating technology access for patients as well as providing training on technology both from on the provider’s side and the patient’s side. So just helping with that technology piece did come up in the survey.
Dr. Amy Gajaria: And I’ll jump on what you’ve said, Amanda. Not everybody knows that Wi-Fi, high-speed internet access is not available throughout all of Canada. And so access to reliable internet has also been something that we’ll talk about as really important for northern communities because often it’s expensive. You can’t stream in the same way. It’s lagging. And so I think that’s just important for people to know that it’s not universally accessible across the country.
Dr. Sagar Parikh: So the technological challenges are at several levels. At sort of societal level, do we have internet access that’s reliable? At an individual level, do people have the devices that can take the visit and administer it properly? So those are some of the practical things. But then there’s the human element. Do we know how to use these tools properly? And I think it’s particularly incumbent on the doctors and other clinicians, have they actually had training in how to make a virtual visit more effective? Dr. Gajaria, what kind of training did you get in virtual visits in the technology or in the psychology of how to talk to someone in a virtual visit?
Amy: So I had a little bit of training. We’d done — You have to do some telemedicine training in your psychiatry residency now. So I have a little bit of that. That was more when we were using OTN Suites. In that way, we were doing the personal visits. I’m very comfortable with it so I think that was not so bad. There are things that I think we didn’t, we weren’t prepared for, we weren’t expecting so like the eating disorder thing that I brought up. But also part of the amazing things is that you’ve had a lot more access but that’s the challenge as well. On the other side, we didn’t expect a lot of things that — I work with a lot of people that use substances. They might show up intoxicated. They might show up in a much worse place than they would have come to an appointment with. And all of these questions about now what do you do if someone is, you know, intoxicated or they’re using or all these things they wouldn’t do. And so I think there’s a little bit of training but I wouldn’t say a large amount of training and a lot of it was learning on the fly.
Dr. Sagar Parikh: So there’s an educational opportunity that the healthcare system should pay attention to what kind of training should be given to healthcare providers, not only handling some of the more mundane aspects like technology but also handling some of the more delicate issues such as how do you help somebody who’s in obvious distress over a remote visit. Well, doctors need some training in that for sure but, you know, as healthcare consumers all of us, we all have to consume healthcare services at some point do we ever get any kind of guidance on how we should relate to our healthcare providers, how we should prepare for a particular kind of visit. I don’t know. Graham, did you have any kind of guideline given to you or any advice given to you as the transition to online care happened that, you know, do this or do that either around technological aspects or how you should talk? Did you get any kind of guidance?
Graham: So honestly, I got no guidance. I was just told here’s the link, click on the link, to have your camera on, and be there at this time. The doctor shows up and you talk about what you want to talk about. So for the most part it’s not difficult like you get the email, you set up the appointment, you click on the link. I mean, I’m young and I know how to work technology quite well but for me, it wasn’t at all a difficult task.
Dr. Sagar Parikh: Yeah. So as you said, you’re a digital native so you know how to handle all that part. So you know how to enter the room. Amanda, what do you think people, we should be doing from a societal perspective? There’s obviously no training for individuals who are about to consume these services. There’s limited training for the treatment providers. Did that come up in your survey or in what you’ve read on the material? How should we be preparing as a society for enhancing virtual care?
Amanda: I think that’s a really important point. We did ask people in the survey, both users and providers, whether they required assistance to access the remote care platform and almost all of the healthcare users said no, they did not need assistance. I think it was about 94% said they were okay without assistance but about a third of the providers did require assistance at some point. And that could be from the provider’s side, the setup might be different and seeing multiple clients. It’s understandable that that might be what’s driving that. But I think the issue of training and preparation for this kind of remote shift is really important and even things that came up in the survey that I hadn’t considered like one healthcare user reported that eye contact was a challenge. So they said when my provider takes notes, it’s difficult because all that I can see is that they’re just looking down from the camera. I can’t see that they’re writing. It’s not the same as in-person. I just see that they’re looking down somewhere else and I can kind of infer that they’re taking notes but it just sort of leads to a little bit more of a disconnect. And even things like looking at the webcam instead of looking at the screen where someone’s face might be slightly offset, little things like that, I think can make a big difference in the remote care experience but people aren’t really trained on that. And one thing that did come up in the provider responses was a need for training so I think that’s really important.
Dr. Sagar Parikh: Thank you, Amanda. So just a couple more points for us to ponder. So I’m going to ask each of you to just summarize one or two of the main benefits that you’ve seen with your experiences so far with virtual care and maybe one cautionary note or downside. And later on, we’ll do another round of what should the future hold for virtual care. So Graham, to start off with you in terms of a couple of the most positive things that you’ve seen with virtual care and perhaps one or two sobering messages as well.
Graham: The biggest positive aspect is that it’s very convenient. I can just wake up or I just sit at my desk and my laptop and it’s just very convenient. I don’t have to travel to a doctor’s office. So that’s really only, the only positive aspect I could see for me. In terms of possible negative aspects, like I said there is like kind of a distant feeling when you’re talking to your doctor which can possibly create some problems. Like I said I’ve met my doctor in person several times. We already established that level of trust. And I think a big thing for me, you know, I’m doing quite well now but when I wasn’t and that was for quite some time, I needed a lot of reassurance from my doctor and it’s kind of hard to convey reassurance over the computer because I would be talking to my doctor and I thought I was going to be unwell or sick forever and he would just constantly reassure me but it was kind of hard to believe it because I wasn’t seeing him in-person. I just felt a lot more like I said emotionally disconnected. So those are some of the more, some of the downsides in terms of online psychiatry, I’d say.
Dr. Sagar Parikh: Amy, some upsides and some downsides from virtual care?
Dr. Amy Gajaria: I think the huge upside is access. I think that’s incredibly important for young people and it’s been so valuable to the patients I work with, both geographic and then also when people are more unwell it’s so easy to see a provider. The biggest challenge I would say is that sometimes you need people when they’re not doing well to be able to leave and to get more structure and to come to your office and to face some of that. So when people are more anxious or they’re more depressed, sometimes there is therapeutic value to leaving the house into coming to an appointment especially if that’s all somebody is doing. So I think that’s been harder for folks and it’s been harder to kind of push people around that to kind of get out and do things.
Dr. Sagar Parikh: Amanda, upsides, downsides?
Amanda: I will echo a lot of what has already been said. I think convenience is a big one as well as continuity of care. So in the pandemic being able to still see your healthcare provider albeit remotely. And people being able to have these visits in the comfort of their own home, that came up consistently as something that was helpful as well. In terms of drawbacks, again, sort of what has already been said that kind of increased distance and potential loss of connection between the patient and the provider especially if it’s an audio-only situation. So losing those non-verbal cues and body language and all of that seems to be particularly challenging.
Dr. Sagar Parikh: Amanda, what would you think if we had so-called virtual angels — These are individuals hired at institutions to be like, you know, people you turn to regardless of whether you’re a provider or a patient and you want to have a better experience or you’re in active need of troubleshooting advice. The idea of having some sort of supporter or assistant or virtual angel. What do you think of that?
Amanda: I think that’s a great idea. I think that would help on both sides with getting people connected and minimizing the technical issues and all of that.
Dr. Sagar Parikh: So Amy, I’m going to give you a slightly different question and that is, what advice would you give to patients to make the virtual experience better for them? What should patients do differently or how should they prepare for a virtual encounter to make it more fruitful?
Dr. Amy Gajaria: I have some rules that I think helped. One is that it can be really tempting to sleep until your appointment starts and then to see your provider in bed before you’ve like had a shower or eaten. I don’t know if that’s the best experience! If you’re able, I think it’s nice to like get up, sit in a different room or space, sit up, be in a private space, so be able to really focus yourself on the appointment so you’re getting the most out of it. And I think those are the main things I would say. People actually do a great job at being prepared. I think those things — That’s the big thing in my patient population, the teenagers, it’s the temptation to stay in bed and I think it does help to get up and get out and have maybe a shower and be ready to go. I think it just helps you feel more alert.
Dr. Sagar Parikh: Thank you, Amy. And I can tell you’re a child and adolescent psychiatrist. I’m strictly an adult psychiatrist and luckily I don’t seem to have the problem of too many patients being in bed and not having showered when they come on online. But I do happen to have three teenagers in my home and yes, that is an issue there. Graham, how about, the parallel or the mirror question for you, what advice would you give either therapists or doctors so that they do a better job of relating to the individuals in a virtual visit?
Graham: So if I’m just thinking about my doctor personally who in my opinion does a great job, he’s amazing, he tries his best to maintain eye contact with me and we can at least make some form of connection. Try your best to convey the acknowledgement of what I’m telling him so I can at least feel that he’s absorbing what I’m telling him and that he cares and he wants to help me and whatnot. And then I guess just more so on my end, I mean, I do this in person too but every time I come to an appointment for me so we can work on things is I just take notes and then I show up to every appointment prepared and then we can talk about whatever I’m dealing with but I think overall just trying, for the professional, the doctor, the therapist, just trying their best to make it as human as possible.
Dr. Sagar Parikh: Thank you, Graham. Well, making it human. Isn’t that what it’s really about? We’ve heard today from a panel of individuals who’ve told us about some of the challenges and some of the benefits of the transition from face-to-face mental health care to virtual care, virtual care on the phone, on Zoom or on other platforms. We’ve heard about some of the problems. We’ve heard about a lot of benefits and in that last piece, you heard some tips, tips for patients, tips for doctors and healthcare providers, on how to make things differently.
So with that, I’m going to thank all of the panel members for really participating in a, yes, virtual discussion on virtual care. Thank you all.