Clinical Telemedicine Experience

Comments on clinical telemedicine experience from
Sara Gibson MD, HCIC Telemedicine Medical Director

I have been providing services over telemedicine for more than 21 years. Over telemedicine, I feel confident in the accuracy of my diagnoses and evaluations, and am able to establish excellent rapport with my patients.

I 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 (16 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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