Deep TMS is a new paradigm, and creating a thriving Deep TMS practice requires a change of mindset and a new approach. We asked some of our successful clinics to share their insight about their own success, and will deliver these valuable tips to you in a series of articles.
In this article, we'll focus on patient-related tips, from targeting the right patients at the right time, through ways of introducing the treatment to the patient, and all the way to engaging the patient after the treatment.
Targeting Existing Patients with TMS Potential
By Aron Tendler, MD and Brainsway's CMO
To expand our Deep TMS services, we need to start focusing on depression patients who are appropriate for Deep TMS. Actually, the most relevant patients for Deep TMS are not referral based, but your own patients – those you are currently treating. Rather than being a referral based service, Deep TMS should be a treatment option for your own patients.
In every psychiatric practice, a large percentage of patients fall within the Deep TMS approved category – patients who do not respond well to medications. There is a 7% prevalence of depression in the US population, meaning 15 million depressed people every year, many of them with TRD.
Therefore, Deep TMS opens up an incredible avenue that can help an enormous number of patients. When a clinic has 40+ patients a week, at least 10% are candidates for on-label Deep TMS, as most of them have tried and failed antidepressants. We need to be thinking: "This patient has tried medications – now let's try Deep TMS. Every day, we need to be thinking "How can I help this patient?"
Managing Patient Expectations
By Martha Koo, MD
It is important for patients to understand what Deep TMS can – and cannot do. Part of a successful TMS practice requires properly addressing patients’ expectations and letting patients understand that treating their depression doesn’t mean that they will magically find their ideal partner, love their job or feel happy all the time.
Patients should also be educated about when and how to expect improvement. In general, most patients experience improvement in restorative sleep, energy and motivation around the tenth session. More sustained mood and cognitive improvement is expected toward the end of the acute phase. When their mood change lags behind, patients may experience feelings of despair or fear that the TMS treatment is not working. In these cases, depression rating scales provide the doctor with hard evidence of objective improvement. The doctor can then share this improvement with the patient and say, “Look, your sleep is better; your energy level is improved”.
Selling the Treatment to the Patient
By Aron Tendler, MD
Any treatment has to eventually be "sold" to the patient. Deep TMS is relatively easy to sell, as it has tremendous advantages, such as no systemic side effects, high effectiveness, and more.
When patients refuse Deep TMS, you can let them try yet another medication, and if that fails, you can re-suggest Deep TMS. People don't always go for the first option you offer them. Also, it's nice to be able to take them to the next room and have them see the device and how benign it is.
"A Doctor is a Salesman for Change"
A doctor is not Google, and should not present a list of 20 different options. A doctor is a salesman for Change. You need to present the options in a way that will sway the patient in the direction of the appropriate treatment. The order of presenting the solutions is very important. This can make huge differences in patient retention, and in getting patients to come back for any kind of treatment.
One relevant technique is Rejection-Then-Retreat: Suggest a more extreme option to achieve a moderate one. When a patient has failed 4 medications, you could say: In this situation, the most effective treatment is ECT, with 80% chances of success, but it has cognitive side effects, no driving for 6 weeks, anesthesia and seizures 3 times a week. Afterward, you can offer Deep TMS, and people are likely to prefer it.
Engaging Patients after TMS Treatment Completion
By Saad Shakir, MD
Keeping patients in the loop and educating them after they finish Deep TMS treatment is important. With some high risk patients, I set up regular checkups. With other patients, at the end of the treatment, I sometimes tell them that here is a 50% chance they may need more TMS down the line.
One patient recently contacted me, saying he needed a booster, and he will be receiving five treatment sessions. Fortunately he came in when he was just 10% into the depressive episode, which enables us to control the situation with just a few sessions. This prevented a full-scale depressive episode which would have required a full-length treatment.
Treating the Right Patients, at the Right Time
By Martha Koo, MD
To have a high success rate with Deep TMS, distinguishing between biological causes and psychological or situational causes of depression is crucial. Deep TMS can treat biological depression; psychological or situational factors would be better served by other interventions.
In consultation, I strive to identify the true causes of the depression. For instance, I had a patient suffering from depression as well as chronic pain. We started with improving pain management, and, not surprisingly, the depressive symptoms resolved soon after.
It's also important to not focus on depression alone but to understand the patient as an individual, including current life stressors and life situation. If a patient is experiencing a traumatic divorce, extreme work stress or a chaotic transition, it may not the best time for TMS treatment. Wait until these life factors can be stabilized and then schedule Deep TMS.
When patients arrive for a consultation, I perform a comprehensive intake in order to properly identify the causes of the depression, to determine whether TMS is indicated, and to coordinate the most effective time to initiate Deep TMS.
Coming up in our next newsletter: Business-related tips for building a successful practice based on Deep TMS