Friday, February 5, 2010


Another med management visit today. This is like a virtual house call. I actually did a couple real ones when I practiced in Manhattan in the 80's. You get a little more feel for the patient, and you may get to meet the pets when you see the home, even the office.

I recommend routine "visits" to very stable patients the first time you try this, and this kind of visit serves another needed purpose. Many patients I treat have been and will be taking the same medication for years. As far as I'm concerned I one visit per year should suffice, but my malpractice risk managers recommend more frequent visits. For example, you should always make sure to have patients come in the day before a suicide attempt. This really is risk management mentality, and of course in an ideal world we would do that, but the patients I describe will not likely try to hurt themselves, and have the sense to call if things start to fall apart, or they just want to talk about a change in treatment.

The other reason for more than once yearly visits: $. What I charge barely covers the cost of the visit, not to mention the med refills and liability that have become fixed costs per patient. My patients do not want to come see me every three months, much less pay for it, but with at least with a visit via Internet the inconvenience of the trip, and the attendant risks, disappear. I figure even after I get used to Skype I will want even the most stable patients to come to the office once a year, but if we can conduct 2 out of 4 or 3 out of 4 visits via Skype, I get adequate quarterly "dues," the risk managers can sleep at night, and I minimize inconvenience to the patient.

What were the risks attendant to office visits?
  • Cost of gas, increased carbon footprint, global warming, climate change
  • Risk of motor vehicle accident
  • Risk of running into your neighbor in the psychiatrists office: "Joe, I didn't know you were mental!"
  • Time missed from work
 I think I'm going to like being a Skypiatrist.

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