Problem with Pdoc's Insistence

Like so many of us, I have been doing both pdoc and therapy appointments by ways other than in person. Yesterday I had a telephone appointment with my pdoc. It was a pretty straight med check appt.

I told her that I'm having some tremors. I have been seeing her for over 3 years, so she has to know what my hand tremor looks like by now.

Well, she went into a tirade about how I need some kind of video set-up. She said she's been told that the clinic "might not get paid" for telephone only appointments. She also said that using the phone only could cause "medical malpractice." She finished her lecture by telling me to ask the receptionist about how the clinic could help me set up a video system.

The thing is, no way do I have the $ to buy a web cam. I have absolutely no idea of how to hook it up. Plus, all computer shops are closed now.

I was really upset. I called the receptionist, who is a very kind person. I explained to her that I do not have a web cam, I have only a PC (so a microphone isn't built into it). I do have a cell phone, but I use it only for car emergencies if I'm traveling, break down, and need to call roadside assistance. My cell is not connected to the internet. It's an old phone and I don't even know how to do Face Time or whatever.

The receptionist told me that pdoc needs to calm the eff down, and that no client has to have video capability to have an appointment with pdoc or therapist. The clinic cannot force people to pay for equipment they cannot afford to buy, nor does the clinic provide service to set up video in someone's home.

My pdoc often tells me to buy stuff that I have zero money to buy, She has to know that I'm on Medicaid, yet she seems to have no clue that my income is very low - as is the majority of patients that come to the clinic.

I have another pdoc appt. next week and I am a nervous wreck because I know she'll rag on me again. Using the telephone to communicate with my pdoc and T is not my first choice by any means, but since we cannot meet in person, we're stuck with phone appointments for now.

Does anyone else use only the phone for psych appointments? Am I a total freak for not having a video set up? Any ideas? I'm feeling miserably anxious about my next appointment with her. On Tuesday, I'm going to talk with my therapist about this issue, but I don't think she'll have much information for me.

I don't know what to do.

That's ridiculous. You're right that not everyone can afford a webcam! She should NOT demand or even expect you to buy things you can't afford.

Maybe I'm just a cynic, but I have a hard time believing that she "might not get paid" for telephone only appointments. You're utilizing her services, whether you see her in person, talk on the phone, or use video chat. Even if it were true, she could argue that the current "situation" leaves her with no choice, and then she can fight it herself. She needs to vouch for herself instead of making HER problem YOUR problem.

Also, I do not believe for one minute that using the telephone puts her at risk for getting sued for "medical malpractice." Your pdoc DOES take emergency/urgent calls, right? Or at least she lets you leave voicemails? Whenever you call her or leave a voicemail, you're giving her your medical information. So why, all of a sudden, is talking over the phone considered "medical malpractice"?

In general though... I know that my therapy office has a rule about this sort of stuff: if you're not seeing your pdoc in person anymore but you need an Rx, you will pay your copay (defined by your insurance) because you're utilizing the pdoc's services. Doesn't matter if you're doing it on the phone, video chat, or whatever. It's always been like this since I started 5 years ago.

As for setups go... You could try your phone. I know you say it's old, but... what kind of phone do you have? Maybe I can help?

Right now my psychiatrist appointments are over the phone. I don't understand why your doctor is acting that way. Sorry you're having to deal with that

How can they demand you do video calls? Jeez. Phone call should be enough!

In all of the thousands and thousands of patient encounters I have had over the years, I don't believe I have ever once mentioned concern about me not getting paid during such a visit. It is just totally unacceptable provider behavior, in my opinion. So sorry you had to listen to that heartless,selfish, inappropriate talk from her. She sounds like a jerk.

BethRags, I can't help but think that your pdoc is somehow unwell right now. Obviously, I can't know that, but it's hard to understand what other reason there could be for her behavior. Based on the reaction of her receptionist, it almost seems like the receptionist is in the know about something amiss with the pdoc.

If any of my speculation is correct, I would of course have compassion for your pdoc, but the fact is that your pdoc has taken on a job with great responsibilities. I hope that if your pdoc is wrong, that the receptionist (and possibly others) will communicate concerns to someone that could help.

All my therapy appointments from here on out will be over the phone (unless it's an emergency, she's in the office on Mondays for situations that need face to face communication, but no webcams needed). I don't see a huge difference between phone call and video chat, so I don't see what the problem should be???
I hope you can work something out with your pdoc

I'm sending hugs. I'm sorry pdoc is being a pita

I couldn't afford a web cam either. My phone is a smart phone but I've never been able to Skype or Facetime with it. I haven't heard one way or the other about this except my case manager said I can call her if I have issues. I think its a little rediculous that your pdoc thinks seeing a choppy image is going to make the appointment go any better- in fact, it may just be distracting and take from the appointment in general.

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Originally Posted by bluebicycle That's ridiculous. You're right that not everyone can afford a webcam! She should NOT demand or even expect you to buy things you can't afford. Maybe I'm just a cynic, but I have a hard time believing that she "might not get paid" for telephone only appointments. You're utilizing her services, whether you see her in person, talk on the phone, or use video chat. Even if it were true, she could argue that the current "situation" leaves her with no choice, and then she can fight it herself. She needs to vouch for herself instead of making HER problem YOUR problem. Also, I do not believe for one minute that using the telephone puts her at risk for getting sued for "medical malpractice." Your pdoc DOES take emergency/urgent calls, right? Or at least she lets you leave voicemails? Whenever you call her or leave a voicemail, you're giving her your medical information. So why, all of a sudden, is talking over the phone considered "medical malpractice"? In general though... I know that my therapy office has a rule about this sort of stuff: if you're not seeing your pdoc in person anymore but you need an Rx, you will pay your copay (defined by your insurance) because you're utilizing the pdoc's services. Doesn't matter if you're doing it on the phone, video chat, or whatever. It's always been like this since I started 5 years ago. As for setups go... You could try your phone. I know you say it's old, but... what kind of phone do you have? Maybe I can help?

Thank you so much, blue. I also believe that she was handing me a line of crap about getting paid and about malpractice. I usually see her once a week; I'm thinking that I'll cancel the coming week's appointment and stretch it out so I communicate with her less during this no-contact time. The last darn thing I need is a pdoc that is adding to my stress.

You are so, so kind to offer your help with my cell. If I was motivated, I would take you up on your offer. Unfortunately, I really don't feel like going through all the hassle jut to appease my pdoc. But I am so grateful for your kindness

I have not used phone only for a psych appointment, but I had a telemedicine appointment that phone only. It was through Blue Cross Blue Shield and they have the option for phone or video appointments. Also, for my therapy appointment we used the platform Vsee which offers audio only (although I used video). I assume that means you don't need to have a camera to use the app? Maybe you could look into this as it is HIPAA compliant. I am not sure about the payment issue (and think it odd they brought it up), but if they are looking for a formal platform this could be an option maybe? Not that it's your job to figure that out, but in case you're interested: VSee Tutorial - How To Turn Off Your Video

Thanks to each one of you for your replies and support. My pdoc has been flipped out over the virus since the moment we started hearing about it here. Her office is stocked with large cans of Lysol, wipes, bleach, hand sanitizer...it's overboard.

I've decided that if she keeps pressuring me about the video stuff I'm going to speak to the clinic director and clarify things. I don't appreciate being lied to by my psychiatrist! The not getting paid and malpractice...so obviously ridiculous. I, too, think she's gone off her rocker with all of this.


And yes - she's known around the clinic as a weird person who is difficult to work with...i.e., the receptionists and nurses roll their eyes about her and tell me to just ignore her personality.

Moose, my experience with video medicine has not been good. The images are (as you pointed out) unclear and very distracting.

@yellow_fleurs: I use VSee too. There are actually two VSee apps -- VSee (the original) and "VSee Clinic."

The Clinic app has a "waiting room" feature where you log in and your pdoc/therapist clicks your name to start a call. (It's basically like a regular chatroom, except instead of clicking someone's name to type a message to them, you click the person to start a video or voice call. But if you're a patient in the waiting room, you cannot see other patients who are "waiting" there. Only your provider can see who's there.)

The regular VSee app has no such "waiting room" feature. Your pdoc/therapist has to know your email address in advance, they send a request for you to add them as a "friend," and THEN they can call you and you have to pick up the phone. It requires more setup and isn't as user friendly as the "Clinic" version.

Both apps allow you to disable the video if you want. There are buttons that show up on your phone screen that you can press. For example, here's a screenshot from my phone:

Thanks for the explanation, Bluebicycle!

Hugs Beth. I haven't read all of the responses to this thread and I imagine all of the wise souls here have nailed this, but I want to reiterate you did nothing wrong. We are all experiencing change and it seems to be difficult on most people. I think your pdoc is included. Her future may feel threatened and she may have other issues bleeding into her time with you.

My advice would be to just use what you have and be confident you're doing the best you can. If she continues to pitch a fit, this might be a sign to shift providers in the future. Doctors sometimes forget patient care is the first priority. Forgiveness of this is a gift you can offer, but if it continues you have every right to find someone more aligned with your values.

My Pdoc and T are only doing phones sessions. I doubt they will ever do video chats. The clinic I go to takes top notch insurance to medicaid and no insurance persons.

There has been some issues with some states didnt "allow" for phone sessions, but insurance companies have had to now accept they will be paying for phone sessions..

I am not making excuses for your Pdoc at all.. But this is a brand new think for providers and all of us... I spoke to my T on the phone Wednesday for our first phone session. We had a good session.. I personally am never one that will call between sessions, its my own issue, But he told me he and all other T's and my Pdoc and the NP are all receiving 50% more calls for help... So I think they are under alot of stress because not only are they helping patients in a new way but they are getting more and more calls than they normally take care of... but they also have to take care of themselves.

In Nashville one of the crisis lines providers are receiving double and more than the normal daily calls.

Just be calm when you talk to your Pdoc and tell her you simple do not have a device that can allow for video calls and you do not have the money and say well lets just make the best of phone calls as we can until things calm down.

Again I am not siding with your Pdoc, but Corona is effecting everyone on the planet and I think everyone can get stressed out.

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Originally Posted by ~Christina My Pdoc and T are only doing phones sessions. I doubt they will ever do video chats. The clinic I go to takes top notch insurance to medicaid and no insurance persons. There has been some issues with some states didnt "allow" for phone sessions, but insurance companies have had to now accept they will be paying for phone sessions.. I am not making excuses for your Pdoc at all.. But this is a brand new think for providers and all of us... I spoke to my T on the phone Wednesday for our first phone session. We had a good session.. I personally am never one that will call between sessions, its my own issue, But he told me he and all other T's and my Pdoc and the NP are all receiving 50% more calls for help... So I think they are under alot of stress because not only are they helping patients in a new way but they are getting more and more calls than they normally take care of... but they also have to take care of themselves. In Nashville one of the crisis lines providers are receiving double and more than the normal daily calls. Just be calm when you talk to your Pdoc and tell her you simple do not have a device that can allow for video calls and you do not have the money and say well lets just make the best of phone calls as we can until things calm down. Again I am not siding with your Pdoc, but Corona is effecting everyone on the planet and I think everyone can get stressed out.

Thank you, Christina. Yes. Being level-headed is my best bet.

You know I'm very supportive of psychiatrists and therapists. Sometimes I'm at odds with people on PC over how they treat their clinicians. In your case, I'd be furious. Your psychiatrist was way out of line. Whatever stresses she has going on during this pandemic doesn't justify what she said or how she behaved. You are owed an apology. I don't remember from your post if you are planning to write her an email or letter, but I would strongly suggest you do.

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Originally Posted by sophiebunny You know I'm very supportive of psychiatrists and therapists. Sometimes I'm at odds with people on PC over how they treat their clinicians. In your case, I'd be furious. Your psychiatrist was way out of line. Whatever stresses she has going on during this pandemic doesn't justify what she said or how she behaved. You are owed an apology. I don't remember from your post if you are planning to write her an email or letter, but I would strongly suggest you do.

Thanks, sophiebunny. I'm not planning to write to her - I'm going to tell her, if she goes into the whole thing again, that it is not possible for me to do video appointments.

This is not the first time she's been demanding and odd. I have actually checked into seeing a different pdoc, but my insurance is prohibitive. Most of the time she's a good pdoc; once in a while she goes off. She is definitely a control freak.

Hey Beth,
I am very sorry you've been treated this way. It's clearly unhelpful for you pdoc to act in this manner.

I do understand doctors being concerned about malpractice when "treatment" /observations are limited to the phone and extending this concern to video as well. Pdocs are suppp0sed to be able to dx TD,and they often use observation as a part of their evaluation. If telemedicine continues as the chosen method of treatment, some concessions must be made around major barrier/obstacles.

I have a friend in Japan. Video cafes are huge there. People go into the café, ask to reserve time and a small room. They use the computer to work on some of their online tasks. It's just one way people might be able to participate in telemedicine.

Another possibility might be a local library. I just don't know how much privacy one might have in that setting..

We need creative ideas for procuring computers for people in need..

I am so sorry so many are without the equipment needs. I hope provisions will be made.
I totally agree with fern, use what you have and do so without apology..

Much Love :

Hey Blue,

I'm trying to come up with the minimum equipment needed to participate in a video call.

There are:: phones, computers, tablets . Oh, what about tablets?
There are some very inexpensive tablets or even Kindle Fire tablets. It's likely the non-kindle tablets are best, I think? (In saying "inexpensive," I do realize you, Beth, are trying to live on an extremely limited budget. I do know how difficult it can be )

Please forgive my ignorance here, what would one need to use a tablet for video calls? ie: earbuds with a mic?

Thanks, Blue.

I don't know about tablets. I tried to download VSee and VSee Clinic to both of my iPads (older iPad mini and very new iPad Air) and both apps gave me problems. So I was limited to using my phone and my MacBook Pro... but phone is easier for me. Have not tried it on Windows because I do not own a Windows machine.

It looks like there *is* a VSee app for Kindle (upon a quick Amazon search): https://www.amazon.com/VSee/dp/B01KIVODVC

I do not see VSee Clinic, though.

But yes, a pair of earphones with a mic would work if you're using your computer; same with a phone. However, I don't know what a computer would do if you download the software without having a webcam. I don't know if it would crash or what, but it can be tried.

Phone is probably easiest though. Most phones will work with VSee and VSee Clinic. I've developed Android and iOS apps before, and when you design the apps, you can set the minimum version of the operating system you want to support. The majority of Android apps support Android Jelly Bean (version 4.x) and later, and Jelly Bean came out in 2012... so even if your phone is 8 years old, it should be supported (in theory). But in some cases, they only support Marshmallow (version 6.x) and later, but that came out in 2015, so even if you've had your phone for 5 years, it should work.

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Originally Posted by Wild Coyote Hey Beth, I am very sorry you've been treated this way. It's clearly unhelpful for you pdoc to act in this manner. I do understand doctors being concerned about malpractice when "treatment" /observations are limited to the phone and extending this concern to video as well. Pdocs are suppp0sed to be able to dx TD,and they often use observation as a part of their evaluation. If telemedicine continues as the chosen method of treatment, some concessions must be made around major barrier/obstacles. I have a friend in Japan. Video cafes are huge there. People go into the café, ask to reserve time and a small room. They use the computer to work on some of their online tasks. It's just one way people might be able to participate in telemedicine. Another possibility might be a local library. I just don't know how much privacy one might have in that setting.. We need creative ideas for procuring computers for people in need.. I am so sorry so many are without the equipment needs. I hope provisions will be made. I totally agree with fern, use what you have and do so without apology.. Much Love :

Back in the '90's we had internet cafes here. Computers, printers, webcams. I don't know why they disappeared.

Something my pdoc didn't consider is that almost every store is closed at this time. All gov't buildings except police stations are closed. No library for a month so far Even IF I had the funds to buy a webcam, there's no where to purchase one - and definitely no way to get tech help.