Academic journal article Current Psychiatry

Practicing Psychiatry Via Skype: Medicolegal Considerations

Academic journal article Current Psychiatry

Practicing Psychiatry Via Skype: Medicolegal Considerations

Article excerpt

Dear Dr. Mossman:

I practice in a region with few psychiatrists and very little public transportation. For many patients, coming to my office is inconvenient, expensive, or time-consuming. Sometimes, their emotional problems make it hard for them to travel, and sometimes, bad weather makes travel difficult. I am considering providing remote treatment via Skype. Is this a reasonable idea? What are the risks of using this technology in my practice?

Submitted by "Dr. A"

Diagnosing and treating patients without a face-to-face encounter is not new. Doctors have provided "remote treatment" since shortly after telephones were invented. (1) Until recently, however, forensic psychiatrists advised colleagues not to diagnose patients or start treatment based on phone contact alone. (2)

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The Internet has revolutionized our attitudes about many things. Communication technologies that seemed miraculous a generation ago have become commonplace and have transformed standards for ordinary and "acceptable" human contact. A quick Internet search of "telephone psychotherapy" turns up hundreds of mental health professionals who offer remote treatment services to patients via computers and Web cams.

Physicians in many specialties practice telemedicine, often with the support and encouragement of state governments and third-party payers. To decide whether to include telepsychiatry in your psychiatric practice, you should know:

* what "telemedicine" means and includes

* the possible advantages of offering remote health care

* potential risks and ambiguity about legal matters.

Defining telemedicine

Studies of remote, closed-circuit "telediagnosis" extend back more than 4 decades, closely following mid-20th century advancements in audio and video relay technologies that made space broadcasts possible. (3) Then as now, "telemedicine" simply means conveying health-related information from 1 site to another for diagnostic or treatment purposes. (4) It's an adaptation of available technology to deliver care more easily, with the goal of improving patients' access to care and health status.

Telemedicine usage accelerated as the Internet and related technologies developed. Telemedicine programs in the United States increased by 1,500% from 1993 to 1998. (4) Telemedicine use has grown 10% annually in recent years and has become a $4 billion per year industry in the United States. (5) Recently enacted federal legislation is likely to extend health care coverage to 36 million Americans and require coverage of pre-existing conditions. To make these changes affordable, health care delivery will need to exploit new, efficiency-enhancing technologies. (6)

Advantages of telemedicine

State governments and some third-party payers have recognized that telemedicine can overcome geographic and cost barriers to health services and patient education. (5), (7-9) Although closed-circuit video transmission has served this purpose for some time, Skype--free software that allows individuals to make video phone calls over the Internet using their computers--is an option that doctors are using to treat patients. (10-12)

Research suggests that telepsychiatry may provide huge benefits to medically underserved areas while reducing health care costs. (4) Telepsychiatry can reduce travel time and expenses for professionals and patients, and it also may lower wait times and "no-show" rates (Table 1). (4) Telepsychiatry lets patients see caregivers when winter weather makes roads unsafe. It may allow geriatric patients who can no longer drive to access psychiatric care and it lowers health care's "carbon footprint," making it "eco-friendly". (13)

Table 1
Potential benefits of telemedicine

    Category                           Benefit(s)

Access           Patients can see specialists more readily
                 Addresses regional doctor shortages
                 Reduces health care disparities between urban and
                 rural areas

Urgent care      Facilitates information transfer for rapid
                 interventions

Productivity     Provides a conduit for clinicians to share skills
                 and expertise j Facilitates remote monitoring and
                 home care

Cost             No travel costs
                 Alternative revenue stream for health care
                 organizations that offer more broadly
                 delivered medical services

Patient-centric  Care is taken to the patient
care             Translator services are more readily available

Source: Reference 4

Social media strategies are playing an expanding role in medical education, (14), (15) and this probably will help practitioners feel more at ease about incorporating the underlying technologies into work with patients. …

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