Don’t Forget About Vital Signs in Psychiatry Visits

These days, an increasing proportion of psychiatric care is being delivered online through various telemedicine platforms and organizations. There are certainly some practical advantages to this growing trend—but there are also some potential hazards that need to be carefully considered by psychiatric clinicians who deliver care and the patients and clients who receive it.

One of the potential risks inherent in virtual care relates to being able to obtain vital signs: things like one’s pulse, blood pressure, height, and weight. These are crucial pieces of data (hence the name) that guide important decision-making in healthcare.

Across most areas of medicine, there is an effort to obtain vital signs at every clinical visit. Good psychiatric care is no different in its need to have accurate and frequent assessments of vital signs. Many conditions that psychiatric conditions treat, as well as many non-psychiatric disorders that can present with mental health symptoms, can be associated with vital sign abnormalities.

Further, many psychiatric medications are associated with possible changes in vital signs that can have significant clinical consequences. This most commonly can include both increases and decreases in pulse and blood pressure as well as sometimes major effects on weight.

Psychiatry over the years has been less consistent in its practice of obtaining vital signs at patient visits, and there is much variability that can occur from practice to practice. Most of the time, this hasn’t presented a major problem, and vital signs even obtained somewhat infrequently can often meet the clinical need, depending on the particular treatments being used.

Telemedicine, however, has opened the door for the potential of many more people receiving psychiatric treatment with nobody obtaining vital signs for months or even years. This is a problem that is unnecessarily exposing patients to risk. Clinicians who continue to prescribe without any vital sign input not only put their patients at clinical risk but put themselves and their practices at legal risk, as best practice guidelines when it comes to psychopharmacological treatment typically mention the provision of obtaining vital signs at baseline, when doses are changed, and when patients report potential side effects.

If you are someone who is receiving psychiatric care, whether it be in person or through the internet, it is worth asking yourself and your clinician if vital signs are being appropriately assessed. If the answer is no, there fortunately are a number of potential solutions that include the following.

• Some telemedicine practices have physical brick-and-mortar locations where vital signs can be obtained from time to time.
• Communication between a psychiatric clinician and someone like an in-person primary care clinician can be opened to provide regular vital sign information.
• Checking vital signs at home and reporting them to your psychiatric clinician can also be an option, as long as the equipment is sound and there is good confidence that the numbers are accurate. There now are more and more options for taking vital signs at home that are reliable and relatively inexpensive, and some different equipment may be needed when measuring vital signs in children.

The point here is that both patients and clinicians need to resist the temptation of cutting corners when it comes to good care for the sake of speed and convenience. Getting regular vital signs can be a slight hassle, but it's far less than something like an emergency department visit, dealing with a lawsuit, or other major consequences that can come from ignoring this important component of treatment.