>This is the fifth part of a six part series on telepsychiatry. I have written so far about why telepsychiatry has its place in SC in the treatment of those who suffer from mental illness. I have talked about the setup used to make this intervention happen and the patients who benefit from it. I have spoken about the types of connections that are made every day through telepsychiatry.
This post will talk a little about the disconnects that arise from doing mental health work from afar through the magic of video monitors and computers. There are several.
First, the job of telepsychiatry by default is one that allows me to talk to my patients and be with them without really being with them. I was schooled in a psychiatry training program that emphasized the restraint of any kind of physical contact between psychiatrist and patient, so I have always been used to the maintenance of personal boundaries. However, maintaining personal space has never meant being in a different room or even in a different part of the state as I am now when speaking with someone in an emergency department. The technology we use is so good that one often forgets that there is a screen in front of you as you talk. Still, the lack of close personal contact in the same room is a true physical disconnect that is emotionally challenging.
Another disconnect is the lack of continuity of care once a consult is completed and sent back to the requesting physician. At times I might speak directly with the ED staff to get background information about a person or to ask about medical issues or other concerns prior to seeing the patient. After reviewing that, doing the interview, making my diagnosis and recommending treatment, I send the electronic consult back and that ends my involvement in the flow of treatment. There are exceptions, of course, such as when I am asked to reconsult on a patient who has stayed in the hospital ED waiting for an inpatient bed that might take several days to open up. In those cases, I will be able to review what has happened since my first contact with the patient and make further recommendations based on any changes since that initial examination.
A third and very important disconnect is the physical and emotional isolation for the telepsychiatrist. Working from eight to sixteen hours at a time, alone, can be physically, intellectually, and emotionally isolating for the doctor. Once again, there are regular contacts by telephone, email and videoconference throughout a shift, but this is a radical change for a doctor like myself who has moved from over twenty years of direct clinical work, along with personnel administration, meetings, and supervision of staff, to working literally on my own for hours at a time with no other people in the immediate area. Great care must be taken to maintain stimulation through use of onsite CME, email, reading literature, periodic telephone contact with others and the like. I will speak to this issue a bit more in the last part of this series, Telepsychiatry: The Future.
Next up: Telepsychiatry: The Future. This will be the last installment of this six part series. See you back here on Wednesday.
