No One Size Fits All: The Case for a Balanced Approach to Telehealth and In-Person Care

Mon, 08/09/2021 – 13:59

By Leslie Lundt, M.D, Executive Medical Director at Neurocrine Biosciences

Telehealth use rapidly increased in the early months of the pandemic, fueled by an unprecedented expansion of coverage and reimbursement by health insurers. Because these changes were a response to the COVID-19 public health emergency, they were intended to be temporary. They may not stay temporary, however, as stakeholders, from government to health insurers, weigh whether and how to make the current flexibilities a permanent part of health care in the future.

Today telehealth is at the center of health policy discussions, but many questions remain unanswered. Will the emerging research on telehealth and health outcomes align with public perceptions of telehealth? How will this research be used to inform the types of visits — in-person or virtual — people have with their doctors? And, fundamentally, do we have enough information even to determine which type of visit is best when choosing between telehealth and in-person care, particularly when it comes to mental health care?  Of course, there is no one-size-fits-all answer and flexibility must be a central component of any path forward. As Congress and the Biden Administration examine which path to take, they should consider an approach that uses telehealth as an option that complements — but is not a replacement for — in-person care.

Face-to-face visits should remain an essential part of health care for many people who benefit from being seen in-person by their doctor. This is especially true for diseases and disorders where physical exams are critical for screening, diagnosis and treatment. People with involuntary movement disorders, like tardive dyskinesia (TD), fall into this group. TD is a condition usually caused by prolonged use of antipsychotic medications by those with serious mental illness. For people at high risk of TD, the American Psychiatric Association’s guidelines recommend physical screening for the condition occur at least every six months so that doctors can note even minor changes in movements.

With telehealth, there are substantial limitations on a doctor’s ability to conduct a thorough physical exam: some changes may not be noticed over telehealth, where video quality or the inability to see a person’s full body can hinder a doctor’s evaluation. This means that the use of telehealth without periodic in-person appointments can lead to missed or inappropriate diagnosis, and potentially incorrect treatment. In fact, experts in the field of movement disorders argue telehealth is not a substitute for face-to-face visits, but rather a helpful addition to clinical care.

Clinical experts also note telehealth can impact a person’s ability to provide a full medical history and make it harder for people to form doctor-patient relationships that make care more empathetic and conversation more honest. Similarly, although many psychiatrists indicated they were “pleasantly surprised” they could meet a person’s needs via telehealth, the majority indicated a strong preference to return to in-person care following the pandemic for various reasons that include the need for privacy and building an effective doctor-patient relationship.

The patient voice is a critically important part of the conversation about access to and quality of health care. A leading coalition for people living with chronic diseases argues the “appropriate use of telehealth services requires a balanced approach and should be based on patient preferences, needs and goals.” These advocates also note telehealth should be used with, not instead of, face-to face visits, and patients and providers should together determine the best setting — virtual or in-person — to achieve health care goals.

Where does this leave Congress and the Biden Administration? Clearly, post-pandemic telehealth policies must be flexible enough to support the unique needs of all people — those who may receive the care they need via telehealth, and those who need at least some in-person care. Telehealth policy should protect in-person visits as an essential part of health care moving forward, so everyone has access to care that meets their preferences and needs.


Leslie Lundt, M.D., is an internationally recognized clinician and educator in the neuropsychiatric field. She is board-certified in psychiatry and has over 30 years’ experience in active clinical and research practice. Dr. Lundt is also Executive Medical Director at Neurocrine Biosciences.   


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The Capital City Emergency “Level II” Trauma & Wellness Center will house a “state of the art” Outreach Community Resource Center, that will provide case management, mental health community advocacy, and oversight from the M.I. Mother’s Keeper mental health advocates. 
The Capital City Emergency “Level II” Trauma & Wellness Center will offer patrons access to immediate coverage by general surgeons as well as coverage by the specialties of orthopedic surgery, neurosurgery, anesthesiology, emergency medicine, radiology and critical care.
Our goal is to help people in the best way possible in an effort to preserve and to save more lives in the Nation’s Capital and beyond.

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Mental Health

At Capital City Emergency Trauma & Wellness Center patrons with mental health emergencies that include life threatening situations in which an individual is imminently threatening harm to self or others, severely disoriented or out of touch with reality, has a severe inability to function or is otherwise distraught and out of control, will have access to quality and psychiatric emergency services and referrals.

Physical Health

Whether your life threatening medical emergency involves excessive or uncontrollable bleeding, head injury. difficulty with breathing, severe pain, heart attack, vision impairments, stroke, physically collapsing, or seizure related, rest assured that our professionals will properly assess and evaluate the level of response that will be most needed to help provide stabilized care solutions and minimize complications as well as reduce early mortality.

Holistic Healthcare

We offer healthcare solutions that will support the whole person which includes their physical, psychological, emotional, social, & spiritual wellbeing. Research supports that because your mental state can affect your overall health we support and offer the inclusion of complimentary and alternative medicine(CAM) practitioners and naturopathic doctor recommendations and referrals as a part of our Outreach Community Resource Center’s care regimen and support.


Emergency care can typically result in traumatic injuries for which rehabilitation becomes an essential component of care in trying to achieve the best long-term outcomes for the patient. In addition to speeding up recovery times and helping to prevent further complications, rehabilitative care also helps to support a patient’s self-managed recovery once discharged from our facility. Our Outreach Community Resource Center works closely with our trauma center’s discharge department to assure that patrons requiring these services are linked with qualified professionals who will be accountable to the standard of care required to help the patron be successful in their recovery.

Social Services

Our “state of the art” Outreach Community Resource Center intends to promote “expansive” beneficial community enriching services, programs, case management, & linkage to “approved” partner resources and supports in all of the following intended areas and more:

Social Services

  • Clothing
  • Food Pantry
  • Housing/Shelter
  • I.D. Credentials
  • Senior Wellness Check
  • Toiletries
  • Transportation
  • Etc.

Extended Family Services

  • Child Care
  • Credit Counseling
  • Family Court Services
  • Legal Aide

Career Training

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  • Computer/Graphics Training
  • Culinary Program  
  • GED Courses
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  • Job Etiquette & Grooming
  • Resume’ Prep
  • Sales Training
  • Software/Technology workshops
  • Small Business Training

Return Citizen
Program Partner
(Bridging the Gap)

  • Case Management
  • Temporary Boarding/Housing
  • Transitional Program Registration

Prevention/Intervention Outreach,
Workshops, & Programs

  • After-school Behavioral Health Program
  • Civic Engagement / Volunteer Sign-up
  • Fatherhood Rites of Passage
  • Gun Violence Town Hall Forum
  • Life Coaching & Coping Strategies
  • Marriage Counseling Workshops
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  • Mentorship Training
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Nutritional Outreach

  • Cooking Demonstrations
  • Dietary Programs
  • Exercise Classes
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  • Meal Prep

Community Outreach

The Healthy DC & Me Leadership Coalition is partnering with the M.I. Mother’s Keeper Mental Health advocacy organization to provide outreach services on the community level as an aid in reducing the existent health inequities that many District citizens are facing as a direct result of the presence of debilitating social determinants and the lack of culturally appropriate care choices and realities for community members residing in marginalized and lower-income communities.

It is the vision and intentions of the M.I. Mother’s Keeper Mental Health Advocates organization to help improve the quality of living for citizens living in our Nation’s Capital and beyond by overseeing the delicate linkage to services and by maintaining higher standards of care accountability for deserving citizens of the Nation’s Capital.

For more information or to enroll as one of our service providers, please email us at: