If you read our recent post, “Oklahoma Doctor Disciplined For Using Skype To Treat Patients?” you will recall that an Oklahoma psychiatrist was disciplined for a range of questionable medical practices last month. The circumstances of Dr. Thomas Trow’s discipline are noteworthy, but not just because three of his patients died while under his care, nor because he used Skype to treat one of those patients.
Rather, he was sanctioned because he was prescribing controlled substances without a required in-person assessment prior to using telehealth. While the viability of videoconferencing does not seem to have been the pivotal issue in this case, the Oklahoma board’s actions have led to a vigorous discussion by telehealth researchers and practitioners about the appropriate role of video teleconferencing (VTC) in mental health care.
In an article recently published by WBUR’s CommonHealth, Dr. Joseph Kvedar made the following comment about using telehealth for follow-up only:
We have believed for some time that this technology should be limited to follow-up visits, where the patient and physician already have a well-established relationship. Technologies such as Skype and Facetime allow for a robust conversation, but most doctors’ visits require much more than just conversation. For example, any time a physical exam is required, this technology will not work well. That’s why one of our first pilot studies was to implement video technology for mental health follow-up visits (as did the doctor in Oklahoma).
Our early results are promising. It seems that virtual video visits for mental health offer both the provider and the patient important benefits. For many mental health patients, it can be stressful to travel to the doctor’s office. When a patient is being evaluated for a medication adjustment, for example, they are not at their best. The convenience of having a follow-up visit from their own home can be a big lift for these patients. On the other hand, doctors often feel that the home environment is particularly relevant in sorting out mental health problems. A virtual visit allows them to, in effect, conduct a virtual house call.
A point that is rarely mentioned in many of these discussions is that the vast majority of U.S. states have similar prohibitions against prescribing medication online without an in-person assessment (See CTel’s, “50 State Survey–Internet and Telemedicine Prescribing: Survey of Individual State Policies and Regulations“).
Even more of relevance to allied mental health professionals is that fact that, unlike their medical colleagues, many allied mental health regulatory boards have not yet clearly stated their positions with regard to treating clients online using email, chat rooms or video teleconferening.
Both the recently published American Telemedicine Association (Practice Guidelines for Video-Based Online Mental Health Services) and the American Psychological Association (Guidelines for the Practice of Telepsychology) suggest that practitioners consider an in-person assessment but they have not taken a stand against conducting intakes online.
What are your thoughts about treating clients or patients online without an in-person assessment or intake?