Tuesday, April 20, 2010

WSPA Spring Meeting in Seattle

Stephen Michael Thielke, MD, incoming president of the Washington State Psychiatric Association programmed this years meeting around a theme of technology.

WSAP President Elect Robert Hilt, MD led off with a presentation describing experience of delivering child psychiatry services to remote underserved areas of the state, emphasizing the program's telepsychiatry services in a model providing for remote offices staffed and equipped through the program. I disagree with Dr. Hilt's definition of telepsychiatry excluding the telephone which makes teleconferencing look inadequate relative to face to face contacts. In fact we should emphasize that teleconferencing with video is superior to telephone contact which has been an essential part of standard of care for providing medical services for almost as many years as the technology has existed.

Jacob Sperber, MD spoke next on "The Impact of Interactive Digital Social Media on Psychiatry." However, most of the several authors he quoted have published in other fields, like media and sociology, and it soon became clear that he talked not about psychiatry in general but rather about psychoanalytic psychotherapy. He argued that psychiatry, as though it were some kind of monolithic organization, espouses intimacy as a value, and that psychiatrists should oppose activities, such as social networking, that threaten to impair our capacity for intimacy. I strongly disagree with this position. Social networking clearly has potential for good as well as harm, but psychiatrists should stick to treating mental illness rather than promoting values which, at least in this case, are probably based on psychoanalytic views of what should be considered normal. With his views Dr. Sperber would likely have risen to a high position in the old Soviet Union.

Sperber also argued that digital social networking promotes "multiplicity," in that users portray themselves in different ways in different settings on the Web. That may be true, but we would be pretty boring if each of us always acted the same regardless of the situation. And you don't need the Internet to act differently just for fun, or for some other purpose. I guess if Dr. Sperber's mother told him she cried for the cop to get out of a traffic ticket he would want her to sign up for a several years on the couch.

After lunch VA psychiatrist Kenric Hammond, MD described the electronic medical record system that has evolved over many years at the VA. He focused on the problem of copying and pasting of text and encouraged increased use of narrative vs. check boxes. He also suggested hypertext technology might provide a superior alternative, allowing the provider to refer elsewhere in the record rather than copying the same text. Having reviewed many pages of records from VA clinics and hospitals myself I agree the system begs for improvement. I might suggest a system in which each provider could select modules to customize data entry. It appears to me that the tail too often wags the medical dog. EMR's should bend to the style of the physician rather than dictate how the physician works. On the other hand the EMR, properly designed, might also lead to improved care. The proposed use of hypertext, however, will create change in how forensic record reviews proceed. If the reviewer wants an accurate picture the linked document must be readily accessed from the link. This could apply pressure for abandoning paper copies in favor of electronic. This could be good.

Finally librarian Valerie Lawrence told us how to access journals and other resources available to all WA licensed physicians, and attorney Jacqueline Melonas described risk management considerations in communicating with patients via digital media.

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