Health care models are changing and becoming
more focus on making efficient use of medical resources to serve the greatest
public good. Tele-Psychiatry provides multiple possibilities to address
the needs of communities with a lack of sufficient numbers of psychiatric
resources to address the needs of patients. Those are communities located in
rural areas that are geographically far from urban communities and from larger
hospitals. In those cases, local clinics may not have all the medical resources
to treat psychiatry patients. However, rural hospitals have Medical Clinics
that treat the more basic primary medical needs but not the psychiatric needs
of patients.
In Psychiatry the most important interventions
are directed to resolve or reduce the discomfort of the patient’s illness. The
Physician also has the responsibility to promote empathy and compassion for the
patient’s Mental and Social problems. Patients residing in remote areas away from psychiatrist are able to be treated locally by a variety of Clinicians. It is important for the Tele-psychiatrist to be able to communicate with all
treating Colleges e.g. Primary Care Physicians and other Medical Specialists,
Social Workers, Nurse Practitioners, and all other ancillary Professionals
dealing with the patient’s multiple needs. A Tele-Psychiatrist needs to know
the total environment where the patient resides including the social ecology,
patient’s culture, and physical surroundings.
The Psychiatrist must be trained in cultural
sensitivity and have the ability to work with cultures different from his/her
own and have the capacity to work in consort with language interpreters.
In my Tele-Psychiatry practice, I make efforts
to promote team work by communicating with the other specialists or mental
health professionals available in the clinical settings where the patient
resides. Those other professionals are parts of the communities where the
patients are seen. The development of rapport, empathy and compassion are as
fundamental in Tele-Psychiatry as in traditional face to face encounters.
I make sure that the findings are communicated
to other colleges that are involved in the same case. When this communication
process is not possible or is limited; this constitutes a barrier to the
performance of adequate Tele-medicine. To educate the patient about the
diagnosis and the management of his/her case is a fundamental aspect of the
treatment and enhances the Dr.’s relationship with the patient.
Location where the patient
may be seen by remote. Since 2005
new Technologies are making it possible to deliver high quality psychiatric
care to geographically isolated communities. Presently Tele-psychiatry is used
in settings removed from urban centers where Psychiatric and mental health
practitioners reside and work. Tele-psychiatry provides access to Psychiatric
care for homebound and homeless patients who might be otherwise unlikely to
attend scheduled clinical appointments.
Safety Issues
Throughout the course of the clinician-patient
relationship, mental health care providers should always be cognizant of
patient safety issues. The assessment and management of risks associated with
suicide, violence, and health conditions should always be at the forefront of
any clinician’s mind, regardless of whether the sessions are conducted via
telemedicine or in person.
Rules for
Communication
Patients should be educated on calling 911 or
going to their local emergency department in the event of a medical or
psychiatric emergency, and the tele-psychiatrist should have the full phone
number of the patient’s local Police Department.
In summary, in Tele-Psychiatry the ground rules
of interaction between physicians and patients are similar to all rules of
communication. Should avoid loose ends. Ensure that patients understand
what the physician tries to convey. Inform and clearly define the treatment
goals to the patient and his/her family. To listen to the patient’s
complaints with empathy and respect. To clarify patient's and their families’ about
outcomes and treatment expectations.
Tele psychiatry teams
A team could be formed and located in an
institutional setting like a hospital or small clinic.
Communications should be fluid and flexible
between team members: psychiatrist, physicians, nurses,
physician assistant’s (PA) and social workers, etc.
Communication with
significant others
Communication should also include other members
of the patients’ environment: examples are friends, neighbors, distant or close
family members, older children; these members may be educated and able to
attend sessions at the site were the patient is seen.
Significant others need to have the
acknowledgement and permission of the patient and respect the patient’s
privacy. Patients and relations need to be educated as to the ethical rules
regarding privacy and confidentiality. HIPAA Rules need to be considered when
the Tele-Psychiatrists involves others in the treatment.
Professional Cases
Consultations can be Direct with the
patient present during the consultation or the Indirect with other
professionals that consult about the Mental State of the patient or about
considerations of treatment and planning when the patient is not present.
Services provided by Doctor Aisenstein (MD-Telepsychiatrist);
1. Psycho-Pharmacology consults and Medical Management.
2. Study Groups to address a particular area of Tele-Psychiatry.
3. Video-conferences with many presenters in a particular area.
4. Review of records and peer review for legal issues, insurance and
ethical conducts.
5. Group education.