One of the features that sets my practice apart is the option for asynchronous visits—where instead of scheduling a live appointment, you submit a secure video update, and I respond by the next business day.

This model isn't for everyone, and it's not for every situation. Here's how to think about when it makes sense.

How asynchronous visits work

You record a brief video through our secure patient portal. You walk me through how things have been going—what's improved, what's gotten worse, any side effects, any new concerns.

I review the recording, assess what you've shared, and send back my response. That might include medication adjustments, recommendations, questions I need answered before making a change, or a request to schedule a live appointment if the situation calls for it.

The whole exchange happens without the need to coordinate calendars, take time off work, or sit in a waiting room.

When asynchronous visits work well

Stable maintenance. If you're on a medication regimen that's working, and your check-in is essentially "things are good, refill please," a live visit may be more than you need. Asynchronous lets us stay in touch without the overhead.

Minor adjustments. You're doing well overall but noticing some residual symptoms or mild side effects. You don't need a full appointment to discuss a dose tweak—a video update gives me what I need to make a decision.

Busy schedules. Some of my patients travel constantly or have unpredictable work demands. Asynchronous visits let them stay engaged with their care even when scheduling a live appointment is logistically difficult.

Privacy and discretion. For patients who prefer not to be seen entering a psychiatrist's office—or who work in open-plan offices where a video call would be overheard—asynchronous offers an alternative.

When asynchronous visits don't work

New patients. I don't use asynchronous visits for initial evaluations. The first appointment needs to be live—either by video or in person—so I can conduct a proper assessment.

Complex or unstable situations. If you're in crisis, experiencing new symptoms, or going through a significant change, we need a real-time conversation. Asynchronous isn't designed for situations where I need to ask follow-up questions on the spot.

Diagnostic uncertainty. If we're still figuring out what's going on—whether that's distinguishing between conditions or evaluating a new medication—live visits give me more information than a recorded update can.

When you need immediate response. Asynchronous means next-business-day turnaround, not same-hour. If something urgent comes up, that's what scheduled appointments are for. And if it's a true emergency, that's what 988 and 911 are for.

What makes this different from "telehealth"

Plenty of practices offer video visits. What's different here is that asynchronous is an option, not a replacement. You're not being routed to whoever is available—you're communicating directly with me, the same physician who sees you for live appointments.

It's also not a chat bot or an AI triage system. I personally review every video and make every clinical decision. The technology just removes the scheduling friction.

How to know which format to choose

When you're a member, you'll have access to both live and asynchronous visits. My general guidance:

• Use asynchronous for routine check-ins, stable refills, and minor updates when nothing significant has changed.

• Use live visits for evaluations, complex discussions, medication changes that require conversation, or anything where you'd benefit from real-time dialogue.

If you're not sure, err toward live. You can always shift to asynchronous once things are stable.

The goal

The point of offering asynchronous visits isn't to see patients less—it's to make ongoing care more sustainable. Some of the best psychiatric outcomes come from consistent, long-term relationships. Anything that makes it easier for patients to stay engaged with their treatment is worth doing.

Dr. Faisal Rafiq is a board-certified psychiatrist offering private, membership-based care in New York. To learn more about how care works, visit Private Psych MD.