We continue to live in a world where seeking out mental health treatment may be viewed as a weakness. If you run into your boss at the dentist’s office, you exchange pleasantries, assuming you like your boss. If you run into your boss in the waiting room of your psychiatrist, you often avoid one another. Sometimes, you even worry about your job security.
As a psychiatrist, I have had many patients over the years express a desire for added privacy or anonymity when calling to meet with me. Common are questions about privacy when parking, waiting in a waiting room, or upon leaving a session. While I have no wish to advance societal judgments, I do understand the real need for privacy.
Since beginning a telemedicine practice, I have been struck by the number of people who have sought my care noting that they would never feel comfortable going to a psychiatric office in person. Such patients voice privacy concerns as a reason they sought help via telemedicine. Then, there are the longstanding patients who often expressed worry about anonymity, and now comment how at ease they feel.
There have always been obvious pros and cons to telemedicine. This is one issue for patients I had not contemplated when beginning the practice. I’m happy to report that when it comes to privacy, telemedicine is an easy fix.
Since closing my Buckhead office and beginning a telemedicine practice, much of the year I now reside in a time zone 6 hours behind that of most of my patients. When first contemplating this plan, I saw this as a major hurdle. Little did I know it would turn out to be an added benefit.
Sure, some of my patients who preferred morning appointments were initially displeased. However, when I shared that I would now be available for sessions well into the evening, some patients literally grew giddy.
For years, my 4PM or 5PM appointment times were always the first to fill. Patients would tack their session on at the end of a busy day. Now, the sessions first to fill are at 7PM or 8PM. Those very same patients head home after work, relax for a bit, and have their dinner before we speak.
Some patients have sought out my care solely because I now offer evening sessions. “Is it true you offer evening hours?” Those have been the first words of more than one caller in recent months. “They’re evening hours for you,” is often my response. We both feel fortunate.
At the end of a recent telemedicine session, Jill, a long term patient thanked me for saving her money. I was puzzled and reminded her that my fees had not changed. She explained that because we were meeting remotely, she did not need to secure a babysitter for the appointment. She went on to say that the time to drive to and from our sessions, as well as the session time itself, would often lead to a three hour minimum for the sitter. This had never occurred to me.
Since then, similar scenes have played out frequently. I think of John, a farmer who would travel more than 2 hours each way, and carve out half a day for our appointments in the past. We recently had a meeting where he was using his tablet and speaking to me while sitting on a tractor in the middle of a field.
I have dozens of working professionals as patients who simply close their office door, or find a quiet room for our meeting. They need not get permission to leave work, trek across town, and feel stressed by their time away form the office.
I’ve spoken to college students in their far off dorm rooms, therapy clients away on family vacations. My favorite is Lilian, who remains grateful that I can see her in her home, where she need not leave Michael, her husband of 62 years, who struggles with dementia.
Much of the feedback I have received since beginning a telemedicine practice has focused on how the process is convenient, or easy. I recognize that the potential for saving time and money may be a small issue for many, but for some it goes a long way.
When we think of physicians making house calls, we usually imagine an era of medicine that has long since passed. We’re reminded of the practice from film or television. We rarely get a glimpse of what a psychiatric house call may endeavor, or what it was ever like.
With the advent of telemedicine, physicians are finding themselves in patients’ homes again, if only figuratively. As a psychiatrist practicing telemedicine, I now find myself privy to aspects of pathology and care that escaped me for much of my career.
Consider the story of Melanie, a single woman in her late thirties, who has struggled with panic attacks for more than half of her life. They began insidiously, but grew to consume her in such a way that she surrendered. No decision, big or small, was made without first wondering if it would provoke her panic.
After a few years, she became a recluse, scared to leave her home even to buy groceries. She wanted help. She needed it. She made more than a half dozen appointments with psychiatrists over the years, and failed to show for any of them. She couldn’t leave her home.
She reached out to me about the prospect of helping her through my telemedicine practice. I thought nothing of it at the time. Panic disorder is common. People with panic often become agoraphobic and withdraw. However, after our meeting, I realized I had never met with someone so disabled by her anxiety. We met regularly for therapy. We discussed medications, and I had a pharmacy deliver one to her door. In less than a month, Melanie felt comfortable leaving her home for the first time in more than two years.
She continues to blossom and reclaim her life from panic. She is reestablishing long lost friendships, and building new ones. It’s as though she has awakened from a long sleep. I think of the others still sleeping.