People often ask me if I can really connect with patients via telepsychiatry.
What they mean, I think, is this:
Are you able to really listen to and see and evaluate someone when you’re sitting hundreds of miles away from them in another room and only seeing them on a screen, albeit a large, high definition one?
The answer of course is yes, but there are drawbacks.
There is something to be said for face-to-face, real-time, in-the-same-room discourse. When you’re in the same room with a patient, you can smell last night’s alcohol binge as surely as if you were there with them for every shot at the bar. You can pick up on tiny physical fasciculations or tremors that might be missed on camera. You see the writhing, circular gyrations of the foot of one crossed leg that might not be picked up if the camera is focused in too tightly on the patient’s face. You can see a patient’s nervousness, twitchiness, and physical desire to move about when they are uncomfortable being in the same room with you.
The thing that is hard to replicate on camera is that sixth sense that stands every good shrink in good stead.
The feeling that someone is not really telling you the truth. The sense that the mild paranoia that a patient presented with is about to dramatically increase, and the decision to back off and not ask just one more question. The feelings of tension between therapist and patient that have been described as transference and countertransference in the psychodynamic literature. The feeling that you are about to be assaulted in some very real way. (Yes, I have been hit three times in my psychiatric career, and it’s never a fun thing to go through)
Telemedicine allows us to see patients hundreds of miles away in a timely fashion, providing needed evaluation and treatment services to those who might otherwise go without. it is a wonderful advance in modern technology, but it is not perfect.
Until we can plug completely into someone’s world in a virtual sense, we may miss bits and pieces of their story that would help us provide the care they need.