Universal Telehealth in Australia Begins Today - Here's What You Need To Know

"Universal Telehealth" was announced by Australian Federal Health Minister Greg Hunt yesterday. That means from today, we're all eligible for bulk-billed Medicare telehealth consults in Australia.

Telehealth = over the phone, or over video call eg. Skype, FaceTime, Zoom, WhatsApp. This is really useful for things like appointments to follow up on blood results; counselling; referrals; anything that doesn't require a physical examination. You may be already using Telehealth, whether you’re a clinician practicing it for remote patients; or as a patient who’s received care online or over the phone.

You may still need to attend in person if the doctor needs to examine a lump, excise a melanoma, or other condition.

GPs, Specialists, Midwives, Psychologists, Aboriginal and Torres Strait Islander Health Workers, Social Workers- a range of providers are able to do this (if they choose to), saving you the visit to a clinic, and saving the healthcare worker the added exposures from them going to clinic or seeing more patients in person in an era when we're all social distancing and at risk of bringing #COVID19 home to our loved ones (and lacking Personal Protective Equipment to protect ourselves).

This also helps vulnerable healthcare workers #workfromhome or from other safe, protected premises so the 70-year-old specialist with diabetes for example could continue working safely if they wish.

The ABC has a great article for patients.

Many providers are also offering privately-billed Telehealth consults for those items that are not covered by Medicare, such as Physio and Dietitian consults for non-eating-disorder-related conditions. Your clinic or provider will be able to inform you.

Healthcare workers, check your indemnity covers Telehealth- it should. A phone call or visit to your indemnity provider's website will help.

Also, be aware of the privacy of free software. As mentioned on Avant: "The Department of Health has noted that free versions of these applications (i.e. non-commercial versions) may not meet applicable laws for security and privacy. You should check whether the platform you wish to use complies with Australian privacy and security laws. You can do this by asking the vendor or checking the vendor’s website."

Grateful to the Australian government and to EVERYONE who campaigned hard for this, including the Australian Medical Association​, RACGP, RACP, RACS and other colleges, and healthcare workers and community groups nationwide.

For insights from the Australian Telehealth Conference; read our post here!

For insights from New Zealand healthcare workers from telehealth, including Virtual Ward Rounds, read our article here.

Part 3: Interview with Dr Gregory Sam, Psychiatrist and Director of Conduit Health

First published April 29, 2016

 We hope you’ve enjoyed Greg’s series on starting his telepsychiatry business and his journey to success! Here he talks about dealing with the process of failure, and rising from that, along with future plans for Conduit Health.

You can now view Parts 1 and 2 as well.

Dr Gregory Sam, Consultant Psychiatrist, Australia. Image courtesy of Dr Sam.

Dr Gregory Sam, Consultant Psychiatrist, Australia. Image courtesy of Dr Sam.

Can you talk more about your failure process? How did you deal with criticism and get through failure? (Greg had to resit his exams a few times before qualifying as a consultant.)

Firstly, it’s a humbling thing, and there are some good resources. You should find those consultants or colleagues who can give you meaning to your failure.A lot of people will say, “oh, you did this wrong or maybe you did this wrong.” I’m not saying there should be an external locus of blame, I’ve been through that too- “oh, the college is out of its mind failing me because everyone I know is telling me I’m ready to be a consultant, couldn’t really figure that out. But one thing I was told is, “look at this person who’s now a professor, I know during his training he failed 4-5 times,” so I guess there are some comforting things like that. But it’s also about yourself being able to apply that meaning to your failure. Otherwise you go through all this pain, and you can’t get some benefit from it. And that’s pointless, absolutely pointless except to hurt you.

Failure is just an opportunity disguised as pain. 

So I thought, “I won’t let it hurt me or fail me.” With my career, I did think, “should I be doing this?” but I felt resolved that before failing and before I was in that frame of mind, I knew this was what I wanted to do, and this shouldn’t change it. Just because some people failed or I didn’t pass an exam, I will pass eventually.

My reflection of my failure brought about so many positive opportunities.

Medical people tend to become very disillusioned when they fail. We’re not used to failing, we’re high achievers, and when we do fail, it’s a huge fall, and some people don’t recover from that. Those who fail need support, and I know myself because when I did fail, I spent endless nights on YouTube looking up motivational videos and how to get through failing and how to get meaning from that. I felt alone.

I had colleagues who also failed, so we formed a bond and pushed each other through. They’re not entrepreneurial per se, but we had some support in that we failed together.

I think people should apply some meaning about failure. It’s all too painful an experience to do for nothing. Even if you eventually don’t pass, it’s okay, as long as you did something meaningful. Even if I didn’t pass and dropped out of my training, I took meaning from it, and reflected on it.

In fact, Conduit Health is thanks to failing. Had I not failed, I’d have sailed through my training program, with this inside disgruntlement of “this is what I am”.

Conduit Health, Telepsychiatry Service. Photo courtesy of Dr Gregory Sam.

Conduit Health, Telepsychiatry Service. Photo courtesy of Dr Gregory Sam.

One of my bosses said, “I think this will make you a better psychiatrist, and this is because you now know what it’s like to fail. Previously you had no idea what it was like to fail. You excelled and  succeeded in everything. And now you can see that when your patients fail, you can feel a bit of that.”

The medical field, I think they kind of shun people who fail. And people who do fail, don’t talk about it, because they want to be seen as brilliant, successful, and never a failure. Whereas in business, the more I look, they talk about failure with pride. They go, “I started up ten companies, and all failed before I made Google.” They talk about failure with pride, and those who don’t talk about failure and don’t own it, they’re missing that opportunity to share with people. Everyone fails at something, in one way or another everyone fails at something. And people then tend to hide it and put it in a box and not share it with anyone.

We need to change the culture and say, “it’s okay to fail, lots of people fail, but what will you do with it?”. The famous words from Edison I think were, “It’s not that I’ve found the way to make a lightbulb, I’ve only found ten-thousand ways NOT to make a lightbulb.” 

It’s about mindset change.

It’s like, “ok, I failed four times.” It’s not to say, “I failed and I’m useless,” it’s, “I’ve failed and found four different ways to not pass an exam, and I just need to find that one way to pass it.”

Reflecting on my failures in the exams, what held me back wasn’t anything to do with my knowledge. A lot of people think it’s the knowledge (that makes them fail), not knowing enough. For me, it was the anxiety levels. I went into the exam thinking, “what do the examiners want to hear?” But the time that I passed, I gave that away, I said “I don’t care what the examiners think.”

I think there could be more constructive ways in which our colleges could address failure. One way I think is to talk about it more, and to show that it’s not life or death if we fail, we can get through this, and be more supportive, be able to talk about it. 

By having the courage to say “yes I failed my exams”;  other people find doctors as quite intimidating, they’re seen as being super successful and smart, and when you can bring yourself down a bit and be humble and say “I failed”- everybody fails at something, whether it’s their driving test or something, failure is something everyone has in common, so when I bring it up, a lot of people can suddenly relate to it.

In business, that’s super important, so people are not intimidated by you, they have something to relate to you, and it builds relationships. A lot of my GPs, mental health nurses and staff, they like me for being open about it, rather than hiding it away, rather than bringing across this facade that I’m super brilliant, never failed in my life, top notch.

How do you view competition in business? Doctors have that win mentality, how do you manage that in business?

I welcome competition in business. I feel that if somebody can – if somebody else comes forth, it’s always anxiety related, like, “I must be better than them.” But what I do is look at the competitor, and ask, “did they actually evaluate? Did they actually have new ideas about improving telepsychiatry, did I do that, and if I didn’t do that, why can’t I do that? If there are no competitors, you are at risk of becoming complacent, and competitors bring excitement. So I ask, is there value-add, or do I just have to do my job?It can become about less value, more competing on price point. But I know it’s hard for other companies in this space to compete on price point.

What are your other plans for 2016?

Trying to balance. It’s tempting to focus just on private practice, but Conduit would fall by the wayside. For me, what I’m trying to do is allocate time to Conduit Health and allocate other times for private practice . I’ll try organise more talks for GPs including interstate, hosting events.

I love going out to rural communities and seeing them, they really don’t have much psychiatry services. Same with their GPs, they don’t have much support and can get very isolated without someone coming from the metropolitan areas to offer help.

We’ve received the odd referral from the Great Barrier Reef, the Northern Territory, Tasmania, but I want to increase that. In business I think this is something we do- go back to fundamentals, think “why did I start the company, what did I want to achieve?”

The more isolated rural places, I’d rather focus on them. In the semi-metropolitan places, people travel 1-2 hours, whereas in the NT there’s no psychiatrist for a few hundred k’s.

The other thing will be statistics. Looking at 2015, we’ve been collecting data about how many patients we’re seeing, the outcomes, sending surveys to patients and GPs. Being able to publish them and say “this is where psychiatry services are at, this is what we’ve done.” Entrepreneurship is 24/7. It is on my mind 24/7. Even if you’re not doing something on it, it’s on my mind. My admin staff, everything, it’s on you. It’s like having a baby, it’s 24 hours, no escaping. Something people wanting to get into business need to be aware of. It can be like medicine, it can be all-consuming.

A few years from now, I’d really like to get government involved so that I can provide telepsychiatry services to public hospitals. Public services can be quite stretched, but for a private company like mine, that’s what we can offer.

What are lessons that medical professionals and people from other industries can learn about starting in business?

Guy Kawasaki’s lesson is, it’s not about how are we doing things now and how can we do things better; it’s about, “what is the next curve?” Conduit Health is jumping on the next curve. Not just about how to improve how doctors see patients face-to-face, sure there’s a lot of work to be done there, but if you want to jump on the next curve, (you’ve got to create) innovation.

Not too many doctors by nature are entrepreneurial. A large part of that is because we get comfortable doing our daily job. See patients, make a living. Innovation and startups are a huge risk. It’s out of our comfort zone. We stop seeing patients, and suddenly your startup becomes the neediest patient you’ve ever had. 

It’s important to get this out there. It’s people like you, me, people who dare. And hopefully this will help a lot of people find, “this has been inside me, this has been in the back of my mind, but I’m too scared to do anything about it.

 

Thankyou for your support of The Medical Startup and Greg’s interview. You can view Parts 1 and 2 of Greg’s interview by clicking here and here

If you wish to contact Greg for more enquiries about Conduit Health, or to sign up as a GP or psychiatrist for his service, please emailenquiries@conduithealth.com.au. Conduit Health is also on Facebook

Please note: In the medical world, “consultant” refers to a fully-qualified ie. board-certified specialist. “Registrar” is a doctor who’s a member of a training program and preparing to qualify for this certification. “Resident” is pre-registrar; “Intern” or “Houseman” is first-year out of medical training.

 

Interview with Dr Gregory Sam, Psychiatrist and Director of Conduit Health: Part 1

First published April 26, 2016

 Dr Gregory Sam is a consultant psychiatrist who founded Australia’s first bulk-billing telehealth psychiatry consulting service, Conduit Health, in 2014. Focusing particularly on rural and remote communities, Greg currently runs Conduit Health along with his private practice work in the city. In this three-part interview series, Greg kindly shared his tips for success, the road to Conduit Health, mixing business with medicine, and rising from failure.

Image credit: Dr Gregory Sam

Image credit: Dr Gregory Sam

How did you get the idea for Conduit Health?

I think the idea started during my rural rotation of training in 2009. It was often a whole-day affair to see these clients, 4-5 hours’ trip each way, and that was disheartening to see people suffer so much. It’s supposed to be easy access. But they had to wait ages before seeing a psychiatrist.

So I aimed to fill that gap.

I started because I was so frustrated at the way things were.

I found so many deficiencies in rural mental health care, and thought, how do I improve things? There area lot of difficulties and shortcomings in the system. I was always into tech stuff. So I tried to think of the amalgamation of the healthcare and mental health care sectors. Telehealth was in its infancy then. So I thought, why can’t we assess the patient through telehealth conferencing?

I struggled to get through my exams, failed 3 or 4 times, and started to get a bit disillusioned about my career in general. I wasn’t sure why I wasn’t getting through. A lot of thoughts were going through my head. Is this the life for me? Should I be changing careers? A whole heap of stuff. But I thought, there’s still good things I can do in this field, whether it’s as a registrar or consultant or not. I’ve learnt a whole heap about my specialty through this. 

How long did it take you from having the idea to taking action, alongside your clinical work and studies?

Honestly, a few years. My idea has been since 2009, and it’s very tempting to get distracted by training. I was so focused on training that all these other things I could do fell by the wayside. I had the idea for a few years, but only started something solid in 2014.

I think 2014 was when overcoming all the inertia of starting a business occurred, planning and actually doing things. 

Failing my exams gave me that opportunity to start thinking outside the box. I took 3 months off work to have a break. I think that’s the best thing I did during training. I focused on badminton and other things I like doing, and started to make moves on my company. I had meetings with colleagues and friends in business, picked their brains, tried to absorb as much as I could from them, both guys and girls, to understand what it’s like to get into business. My business friends said, “it sounds like a brilliant idea, why don’t you do something about it?” So that gave me a kick to start.

When I went back to work, I left business for awhile and focused on passing exams. Once I passed, during our year of Advanced Training, I set learning goals on things like, “I want to learn more about drug and alcohol,” and other goals which I did in my day job, and also focused my energy on Conduit Health. That’s when the wheels started turning.

2015 was the launch date. Our first consult was February 2015, so 2015 has been a big year in that it’s a startup, and for most startups it’s about sustaining that growth, so 2016 is another big year. A lot of planning happens with regards to how to continue that growth, otherwise it’s too tempting to have a firework effect where it starts then fizzles up. 

Overcoming inertia is hard, but once you overcome it, things start rolling, and you can’t stop.  It’s a lot of commitment but so rewarding, more rewarding than my day job. I find treating patients rewarding, I can help them and their families as a psychiatrist. Whereas with Conduit Health, I’m helping so many more people across the country. We’ve had referrals from far and wide, from every state, and remote locations like the Kimberley and the Great Barrier Reef. I’m working with primary health networks (PHNs) across the country to expand our reach. 

How does a typical consult run?

Conduit Health, Telepsychiatry Service. Photo courtesy of Dr Gregory Sam.

Conduit Health, Telepsychiatry Service. Photo courtesy of Dr Gregory Sam.

Either the psychiatrist dials in (from their location), or the patient (who’s hosted at their GP clinic) dials into us, then the psychiatrist introduces the consult. We need to say at the start that we’re doing it via teleconferencing, that there’s no one else in the office, and check who’s in the office. This sets the scene so the patient can understand that there are no unseen people in the room. We discuss confidentiality, unless risks in which case we need to notify particular people. It’ll go between five minutes to an hour, we state our aims, then start the diagnostic interview.

The video quality is quite good, but if there’s any lag or dropout, we disconnect and call back. We check at the start, “can you see me? Can you hear me?” We check camera position so the webcam points directly at the patient and so the patient can see us. We also make sure it’s appropriate, eg. the psychiatrist is in a quiet isolated room, not at the beach. We set rules for our psychiatrists. They use the Conduit Health backdrop. 

Sometimes a mental health care nurse will be there. We offer to GPs, if you want to be present for the whole assessment or in the last 5-10 minutes, you can. Some GPs stay for the whole interview, others come in the last 5 minutes and ask the psychiatrist, “what’s your diagnostic impression and what’s your plan?” They can get immediate feedback, (and sometimes help with scripts and so on).

We also get constant feedback from other GPs. My role is partly to ask patients and GPs, “how are you finding the process? Can we make things better for you?” Constantly evolving the company.

One benefit of Conduit is confidentiality. You don’t need to go into a psychiatric facility where everyone knows it’s a psychiatry facility, and sit in a waiting room with other mentally ill patients. Patients have said that’s a benefit, so people don’t have to know they’re seeing a psychiatrist. In a way that’s also bad. We’re not trying to promote stigma of mental health, but unfortunately this is a barrier to receiving care.

How did the name Conduit come about?

I was building a house at the time, and working with the builders, one said, “I want to dig a tunnel under your garden to create a conduit for your electrical wires to go through.” Also from my cardiothoracic surgical rotation in med school, “they harvest the conduit” in bypass surgery, and they explained what a conduit was to me. I then thought about what Conduit Health does, it takes away big distances and gaps.

The logo is a bridge, to embody bridging gaps.Suddenly, 300 kilometres to go to an appointment doesn’t matter anymore. It’s a link, a conduit, from point A to B. So patients don’t have to travel.

I don’t think telehealth will replace traditional face consults, but it can address geographical barriers.

Would you expand Conduit to non-psychiatry services?

The immediate next need would be psychology. It would be great to have psychologists who can do tests and consults. But at the start, I want to focus on psychiatry. Some companies have one of every specialty, but I want to focus (for now). If there is demand later on, for say, neuropsychology, social work, we will expand to fill the need.

What about your plans for aged care?

A big arm we’re developing in 2016 is to work with residential aged care facilities. There’s such a huge need, patients can’t often go see a psychiatrist. Aged care services are often floundering, “can we get the psychiatrist to come here?” but not many psychiatrists want to do that to see one or two patients, it’s not feasible. But we can go in and have a session there, and it’s immediate. So 2016 will be a big year for Conduit Health Aged Care branch. We want to expand to all the big aged care facilities. 

To learn more about Conduit Health, click here

Stay tuned for Parts II and III of Greg’s interview, in which he discusses his business inspirations, his insights on failure, and running a business as a medical professional.