The advent of free consumer video teleconferencing equipment and inexpensive webcams has the potential to revolutionize the delivery of psychiatric treatment. The promise of telepsychiatry is realized through technology as the cost-benefit ratio for the use of this medium rapidly diminishes.
Patients may now receive counseling, medication management, and cognitive based therapies while sitting alone in their own homes. Even in the absence of an in-person examination, the standard of care for traditional outpatient psychiatry is maintained because patients are required to visit with a primary care doctor for physical examination and/or indicated laboratory tests. See my recent Letter to the Editor in Psychiatric Services.
But what are the legal, clinical, and ethical implications when one receives telepsychiatric treatment from home? What implications are there with regard to safety and malpractice? Specifically, how does this process differ from more 'traditional' clinic-based telepsychiatry, in which the patient accesses a remote specialist from a local clinic?
What impact does the Ryan Haight Act have upon the future of telepsychiatry and telemedicine in general?
I would like to invite an open discussion regarding the merits and pitfalls of the use of this medium to deliver psychiatric treatment.
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I am a physician, and also have a programming background. In the spirit of honest discussion, I feel that online only based telepsychiatry is not a viable business or medical practice model. Let's have a discussion, prove me wrong. The Achilles heel of telepsychiatry is the prescription factor, few psychiatrists will prescribe psychotrophic meds to a patient without meeting them face to face. The psychopharm approach is chiefly the difference between a psychiatrist and psychologist or counsellor (although this is rapidly changing). Therefore if the online interaction is limited to fee based counselling, psychologists and counsellors can do it for cheaper. Why would any psychiatrist forgo that advantage that they have?
ReplyDeleteWhat do you perceive as being the specific reasons that so few psychiatrists will prescribe without an in-person evaluation, given that with the exception of not being in the same room as the patient during the interview, the standard of care of outpatient psychiatry is maintained?
ReplyDeleteDoes not the advent of technology necessitate the expansion of the standard?
Hi
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