Search Results For telemedicine

Joseph Burgo shares his experiences using telemedicine in his therapy practice:

No doubt it would be better if my clients and I were able to meet in my office week after week, me inviting them in from my waiting room at the beginning of each session and ushering them out through the exit door at the end. But for people who live in remote locations where qualified professional help is scarce or entirely unavailable, connecting with a therapist by Skype is often the best option. Over the last few years, I’ve worked with an American expat living in Japan, a Ukrainian émigré in Israel, and the scion of a wealthy family in Egypt. I’ve held Skype sessions with people located in remote corners of the United States, England, Australia, and other countries. They had few options for getting the help they needed. …

The legality of Skype therapy is a gray area because most state laws require the professional to hold a license in the state where the client resides. Because I was trained as a psychoanalyst, and psychoanalysis is not a regulated profession in most states, I skirt such licensing laws by offering my services in that capacity. Some therapists call themselves “life coaches” when they work across state lines; others simply ignore the law. The arrival of distance therapy and telemedicine is rapidly rendering state-by-state licensure impractical. As usual, the law lags far behind technical innovation.

Todd Essig points out drawbacks to Skype therapy:

Are being bodies together and technologically-mediated simulations of being bodies together functionally equivalent, at least for the purposes of the psychoanalytic psychotherapy practiced by both Burgo and me?

According to a soon to be published book by Gillian Isaacs Russell titled Screen Relations: The Limits of Computer-Mediated Psychoanalysis and Psychotherapy the answer is a resounding no (disclosure: I wrote the Foreword for this fine volume). In fact, after this book hits the shelves patients and therapists alike will need to be attentive both to the obvious gains from screen relations based treatment and the inevitable losses. Russell effectively demolishes the myth of functional equivalence using her ethnographic study of therapists and patients who have experienced Skype therapy along with lab findings from cognitive and neuro-science, communication studies, infant observation, and human–computer interaction, as well as a deep dive into clinical theory,

According to Russell, in an exchange we had about the Burgo article, when you eliminate the experience of being bodies together you constrain and limit what is therapeutically possible to “‘states of mind’ rather than ‘states of being.’” As a result, reflective introspection gets narrowed. How reflective can one really be when talking to a dashboard iPhone on a long drive?

Previous Dish on telemedicine here. In other therapy news, Tina Rosenberg flags research on providing mental health care to those in developing nations:

Two years ago, I wrote about a research study in 2002 that provided group interpersonal therapy, led by college students and high school graduates with two weeks’ training, to depressed women in Ugandan villages. The treatment was so effective that six months after starting this therapy, only 6 percent of those treated still had major depression.

More recently, similar work has gone on in South Asia. In rural Rawalpindi, Pakistan, the Thinking Healthy Program taught basic cognitive behavioral therapy for only two days to female community health workers with a high school education. The trainees, called Lady Health Workers, then integrated the therapy into their regular visits with pregnant women and new mothers. … Six months later, only 3 percent of those treated were still depressed. The largest study was in Goa, India, where local people with no health background were given an eight-week course in interpersonal psychotherapy and worked with physicians to treat patients with mental health disorders. This, too, was very successful.

These studies were proof that depression could be treated in poor countries by lay people. Now these researchers are trying to figure out how to streamline these interventions to the minimum outlay of resources needed to maintain excellent results.

Lastly, some somewhat lighter fare – Amanda Bloom covers a popular podcast from comedian Paul Gilmartin:

Gilmartin, 51, is the creator and host of The Mental-Illness Happy Hour, a weekly two-hour trudge to the darkest—and most joyful—corners of the human condition. He records the podcast in his hometown of Los Angeles, and the show is built around interviews with celebrities, artists, therapists, and podcast listeners; anonymous surveys; and Gilmartin’s narration of his own struggles with depression, addiction, and overcoming sexual abuse. Thirty-five thousand people download the podcast each week, and some episodes—interviews he’s held with Marc Maron, Maria Bamford, and Adam Carolla, for example—have been downloaded more than 80,000 times. The Mental-Illness Happy Hour website is home to an active listener forum, and the show’s 200th episode aired on November 21.

The podcast serves as a place of community and affirmation for those who struggle with mental illness, including Gilmartin, who has been undergoing treatment for clinical depression since 1999 and has gained clarity on his own issues through talking with his guests and corresponding with his listeners. It was while interviewing comedian Danielle Koenig during episode 16 of the podcast that Gilmartin realized on-air that he had been molested by a neighbor as a young boy, and the revelation that he was a survivor of incest began its slow simmer while talking with radio personality Phil Hendrie on episode 59. …

Levity and humor also keep the podcast from being overwhelmingly heavy, and listeners can expect a dick joke every now and again, in between tales of binge eating, drug dealing and coping mechanisms.

Pregnant With Depression, Ctd

Andrew Sullivan —  Oct 21 2014 @ 8:56am

David Bornstein argues that postpartum depression has been misunderstood:

Postpartum depressions are often assumed to be associated with hormonal changes in women. In fact, only a small fraction of them are hormonally based, said Cindy-Lee Dennis, a professor at the University of Toronto and a senior scientist at Women’s College Research Institute, who holds a Canada Research Chair in Perinatal Community Health. The misconception is itself a major obstacle, she adds. Postpartum depression is often not an isolated form of depression; nor is it typical. “We now consider depression to be a chronic condition,” Dennis says. “It reoccurs in approximately 30 to 50 percent of individuals. And a significant proportion of postpartum depression starts during the pregnancy but is not detected or treated to remission. We need to identify symptoms as early as possible, ideally long before birth.”

Regarding treatments, the following passage from Bornstein brings in a recent thread on telemedicine:

The third model grows out of Cindy-Lee Dennis’s research in Canada, and is important because it illustrates the potential of treating women through interventions over the phone. It thus reduces one of the biggest barriers low-income or rural women face in accessing treatment: transportation to and from treatment and scheduling appointments.

In one clinical trial, 700 women in the first two weeks after giving birth, who had been identified as being at a high risk of postpartum depression, were given telephone-based peer support from other mothers — volunteers from the community who had previously experienced and recovered from self-reported postpartum depression (and received four hours of training).

“We created a support network for the mothers early in the postpartum period,” Dennis explains. “It cut the risk of depression by 50 percent.” On average, each mother received just eight contacts — calls or messages, and the calls averaged 14 minutes. Over 80 percent of the mothers said they would recommend this support to a friend.

Previous Dish on depression and pregnancy here and here.

A Virtual Physical

Andrew Sullivan —  Oct 16 2014 @ 11:21am

James Hamblin makes the case for telemedicine:

If some basic needs were addressed remotely, doctors could focus on more dire cases during their busy office hours. Patients could ask simple questions without needing to take an afternoon off work for an office visit. As of last year, only 12 percent of Americans had ever texted or e-mailed with a doctor, according to a survey conducted for The Atlantic. But about a third of people under 30 were open to having their primary communication with their doctors be online. …

Under the current model, doctors don’t see patients on an ongoing basis. As a result, a patient is inevitably getting advice from a doctor who, because she hasn’t seen what he looks like when he’s not sick, can’t tell whether he really “looks sick”—a gut valuation that remains crucial to effective primary care.

Yet, with the American Association of Medical Colleges projecting a national shortage of more than 90,000 doctors by 2020—especially in rural areas—there simply may not be enough doctors to provide this kind of ongoing care. Telemedicine could play a crucial role in addressing basic needs, particularly in settings where long-term relationships don’t come into play, like emergency rooms. Already, to take one example, a company called Avera Health makes physicians in cities available via video to hospitals in small towns, where they are remotely helping to staff emergency rooms overnight. (They work in concert with people who are on-site. So, for instance, a nurse might perform hands-on work at the direction of an onscreen doctor until a local doctor can arrive.)

Previous Dish on telemedicine, as applied to abortion, here. Update from a reader:

Haven’t we had telemedicine for like a decade now?

Heh. Another reader:

Personal anecdote: the Fortune 100 company I work for rolled out a telemedicine option (“free for 2014!”), so I tried it for a persistent cough I’ve had this week. The doctor told me that in most states you’re required by law to have a webcam, so the doctor can see you and look down your throat, I guess. After hearing my symptoms, she wrote a prescription to my local pharmacy for a strong cough suppressant. Pretty handy, huh?

I decided to get a second opinion. After being told to wear a mask in the office, the Nurse Practitioner did a nose swab (just as much fun as it sounds), diagnosed me with Influenza B, and signed me up for Tamiflu

I have an 18-month-old daughter. I’m sure telemedicine will have it’s place, but I’m gonna stick with the clinic for now.

Abortion By Mail

Dish Staff —  Aug 29 2014 @ 8:02pm
by Dish Staff

Emily Bazelon profiles doctor and reproductive-rights activist Rebecca Gomperts, who “started Women on Web, a ‘telemedicine support service’ for women around the world who are seeking medical abortions.” Why Gomperts’ work matters:

Almost 40 percent of the world’s population lives in countries, primarily in Latin America, Africa, Asia and the Persian Gulf, where abortion is either banned or severely restricted. The World Health Organization estimated in 2008 that 21.6 million unsafe abortions took place that year worldwide, leading to about 47,000 deaths. To reduce that number, W.H.O. put mifepristone and misoprostol on its Essential Medicines list. The cost of the combination dose used to end a pregnancy varies from less than $5 in India to about $120 in Europe. (Misoprostol is also used during labor and delivery to prevent postpartum hemorrhage, and global health groups have focused on making it more available in countries with high rates of maternal mortality, including Kenya, Tanzania, India, Nepal, Cambodia, and South Africa.) Gomperts told me that Women on Web receives 2,000 queries each month from women asking for help with medical abortions. (The drugs are widely advertised on the Internet, but it is difficult to tell which sites are scams.)

Kentaro Toyama explains the limits of telecenters:

[S]tories have sparked high hopes for telecenters: distance education will make every child a scholar; telemedicine can cure dysfunctional rural health-care systems; citizens will offer each other services locally and directly, bypassing corrupt government officials. …

What do people want to do with the technology they have access to? Those of us who have worked in interventionist ICT4D [Information and Communication Technologies for Development] have often been surprised to find that poor people don’t rush to gain more education, learn about health practices, or upgrade vocational skills. Instead, they seem to use technology primarily for entertainment. Telecenter surveys find that when a village has ready access to a PC—connected to the Internet or otherwise—the dominant use is by young men playing games, watching movies, or consuming adult content.

Surprise!