Megan Gerber and Sadie Elisseou are Primary Care Physicians; and Zachary Sager is a Hospice and Palliative Care Physician at the New England Geriatric Research Education and Clinical Center; all at the Veterans Affairs Boston Healthcare System in Massachusetts. Jessica Keith is a Clinical Psychologist at Bay Pines Veterans Affairs Healthcare System and an Associate Professor of Psychology at the University of Central Florida College of Medicine in Orlando. Megan Gerber is an Associate Professor of Medicine at Boston University School of Medicine. Sadie Elisseou is an Instructor in Medicine and Zachary Sager is an Instructor in Psychiatry, both at Harvard Medical School in Boston. Correspondence: Megan Gerber (meggerbe@bu.edu)
Author disclosures The authors report no actual or potential conflicts of interest with regard to this article.
Disclaimer The opinions expressed herein are those of the authors and do not necessarily reflect those of Federal Practitioner, Frontline Medical Communications Inc., the US Government, or any of its agencies.
This case illustrates the ways in which TIC can be applied to telehealth for a veteran with combat-related PTSD who may have experienced additional interpersonal trauma. It was not necessary to know more detail about the veteran’s trauma history to conduct the visit in a trauma-informed manner. Connecting to patients at home while considering these principles may thus foster mutuality, mitigate retraumatization, and cultivate enhanced collaboration with health care teams in this era of social distancing.
While a virtual physical examination creates both limitations and opportunity in telehealth, patients may find the greater degree of choice over their clothing and surroundings to be empowering. Telehealth also can allow for a greater portion of time to be dedicated to quality discussion and collaborative planning, with the clinician hearing and responding to the patient’s needs with reduced distraction. This may include opportunities to discuss mental health concerns openly, normalize emotional reactions, and offer connection to mental health and support services available through telehealth, including for patients who have not previously engaged in such care.
Conclusions
Telehealth expansion is occurring out of necessity in a time of crisis. While VHA is expanding its already robust telehealth program to replace some in-person visits, many other health care systems are just beginning to use telehealth. Trauma-informed virtual care during the COVID-19 pandemic has the potential to ensure and even expand continuity of medical care, offer connection and support to trauma survivors, and enhance patient and clinician resilience in this time of need. Clinicians have a unique opportunity in this pandemic to apply TIC principles early on and to envision how telehealth may contribute to a more meaningful care experience for all and a more equitable future for those we care for.
