Of all the specialties in medicine, psychiatry has, by far, the greatest adoption of telehealth—no other specialty even comes close. Telehealth is especially important for our high-risk patients with TD, many of whom live in remote areas and rely on telehealth for their care. These are patients who are being seen by nurse practitioners or doctors of medicine at community mental health centers, and telehealth allows for consistent monitoring and timely interventions that might otherwise be impossible. So, to all clinicians: Telehealth should not be looked at as a barrier to detecting and managing TD.

Now, there is a belief circulating that in-person visits are automatically better for detecting and managing TD. But honestly, there is no definitive evidence that I am aware of to support that. Both in-person and telehealth patients are underserved, underdiagnosed, and undertreated when it comes to TD. We really need to confront our own belief systems here. Telehealth is not necessarily inferior to in-person care, and it is time that we fully utilized telehealth to its full potential. It is also important to remember that the standards of care do not change just because we are using telehealth. Clinicians using telehealth are still responsible for evaluating TD in their patients who are on antipsychotics, just as they would during an in-person visit. Further, when it comes to prescribing medications and/or adjusting risk factors, all of that can also be done nicely through telehealth.

Regarding the assessments that are needed for the diagnosis and management of TD, the Abnormal Involuntary Movement Scale (AIMS) can work quite well in a telehealth setting. It consists of 7 movement items, most of which are easily visible and assessable even during an average-quality telehealth visit. There is really no excuse not to evaluate a patient properly during a telehealth visit. In fact, studies comparing AIMS assessments conducted during telehealth visits with AIMS assessments conducted during live interviews found the qualities to be similar.

So, again, anything that is being done during an in-person visit can be integrated into a telehealth practice. Asking the patient questions, observing the patient, doing an AIMS examination—they are all doable via telehealth. The only real challenge might be examining the lower extremities, but even that can be managed by asking the patient to walk on camera or by involving family members who can help. It is all about adapting to the tools we have.

Since the COVID-19 pandemic, we have all become more familiar with telepsychiatry, and what we are seeing is not a barrier, but rather an opening for new opportunities. It provides a chance to expand our reach and improve the management of TD, especially in underserved populations. By leveraging tools such as the AIMS and adopting a proactive approach, we can ensure that patients with TD get the care they need, no matter where they are.