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have even discovered an increase in rapport
with certain populations due to patients’
perceived distance and safety (especially for
abused adults and children). Other psychiatrists
within our system have independently come to
similar conclusions. My patients have universally
been positive (after some initial awkwardness)
about receiving care over telemedicine. Only
one patient has ever refused services over telemedicine,
and we accommodated her wishes. Patients perceive
the telemedicine system as very professional,
and feel that they get IMPROVED care. They also
are more respectful of appointment times and
appreciate the team treatment model.
I
consider the overriding issue to be access to
care, which has been vastly improved with telemedicine.
Apache County, despite its very small size and
remote location, has had increased continuity
of psychiatry (8 years) as well as increased
availability since the introduction of telemedicine
(weekly vs. once a month…. prior to the
implementation of telemedicine, Apache County
was unable to recruit a psychiatrist to move
yet only work part time and was considering
once-monthly clinics from Phoenix providers).
Children
and adults are treated in a similar manner with
respect to the provision of psychiatric services
over telemedicine, with some differences. Children
are often more comfortable and have a strong,
immediately positive transference to technology.
They “play games” with the system
and with me. Often they bring with them larger
groups of adults involved in their care (JPO,
CPS, DDD, school teachers) and telemedicine
seems to facilitate this team treatment model.
I also always explain the system to children
at their developmentally appropriate level as
well as obtain adult consent (verbal and written)
prior to use of the system. Rarely, very small
children do not understand that I am “not
a TV show” and am in fact interacting
directly with them, so I have the therapist
and/or parent interact with them while I observe.
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