Shirah Vollmer MD

The Musings of Dr. Vollmer

Tele-Psychiatry for Kids?

Posted by Dr. Vollmer on October 17, 2012

At the risk of sounding like an old fart, I am not prepared to accept the changing nature of psychiatry, yet again! For many years, I have appreciated the advancement in technology leading to Tele-Psychiatry, where people who cannot leave their homes, or who live far away, can connect remotely to a psychiatrist, allowing for access which would otherwise be impossible.  For adult patients, I am excited by expansion of our services. Now, let’s move into Child Psychiatry. Can a Child Psychiatrist do an assessment through a computer screen? It seems to me that evaluating children, working with families, mandates a three-dimensional exposure which would be severely limited by Tele-Psychiatry. As so much interaction is non-verbal, and as so much of an assessment includes “playing” with the child, I do not see how remote communication can simulate this encounter. Two-way communication devices are wonderful advances in medical settings where doctors do not need to touch their patients, but as a Child Psychiatrist, the “touching,” or more specifically, the shared use of space is critical to understanding how a child navigates their world. Some kids come and sit quietly, whereas other kids have a hard time staying still. Sometimes my words help kids focus, whereas other times, a child needs to be active in my office. These nuances will be lost with a remote access device. Once again, I am left thinking that change can be good, but then again, not always. I understand the dilemma between improving access and quality assessments. I also understand that as a field Psychiatry, particularly, Child Psychiatry, has to hold on to the key tenets of the profession. For me, this includes being in the physical presence of a family is an important component to the understanding of powerful relationships and their sequelae. I am not sure I would be willing to compromise on that issue. Technology should aid us in our goals, not detract us from them. Tele-Psychiatry for kids seems to move my field in the wrong direction.

2 Responses to “Tele-Psychiatry for Kids?”

  1. Shelly said

    I don’t understand why this has to be an “either-or” situation. Why can’t you have all intake sessions with your patients (children) in person, and your brief medication follow-up visits done via computer screen? I agree with you that the things that one can see in person is far different when viewed in 2-dimension. Is your opinion different on tele-psychiatry different for the treatment of teenagers and adults than for children?

    • Shirah said

      Absolutely! Tele-Psychiatry can be an extremely important addition to patient care. My issue is that I understand it might be used as a substitute for all face to face encounters. This is my rant. Yes, the point of my post, although I could have been more clear, is that families, particularly with little children need to be experienced in person to make a thorough assessment. With further development through puberty, there is more expressed with words, and as such, Tele-Psychiatry could be very useful. Your points are well taken and appreciated. Thank you for expanding my thoughts.

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