I had an interesting phone call and email conversation the other day. It came to nothing–I didn’t feel that I could help the patient with her problem whether face to face or via telepsychiatry, but it made me think about how much telepsychiatry changes the way medicine is going to look in the future.
The request for telepsychiatry was from a U.S. citizen living in another country. When I got the initial message, I was tempted to just say “no,” but the more I thought about it, the more perplexed I got.
Put aside, for a moment, the issue of licensing. I don’t know what the laws are regarding telepsychiatry in another country right now, and don’t want to become an expert.
What made me think a bit is that I have occasionally treated people who were temporarily out of the country. For example, I’ve had patients who were on extended business trips, visiting their family in another country, or away for an exchange program. I’ve sometimes given someone six months of medications in this situation, even though I usually don’t do that for a variety of reasons.
I’m not sure whether or not this counts as “practicing medicine” in another country. Certainly, I’ve never thought so. Usually, the patient is getting someone here in the U.S. to pick up the meds and ship the meds to them.
As far as I know, this kind of accommodation gets done all the time, and no one has ever told me it was wrong. I guess you could argue that the patient should get care in the other country, but that may not happen, or it may not go well, especially in psychiatry.
So here’s the puzzle. Let’s say I take care of a student, he goes on a junior year abroad, and I write for continuing his antidepressants, with his mother handling the meds here in Maryland. If I have a brief phone conversation or an email exchange with the student while he’s away, I think I’m within the standard of care. Suppose I have a telepsychiatry session with this student while he’s away. Am I now practicing medicine in another country or doing something illegal? It’s seems like I’m doing a more careful job for my patient, not a sloppier one.
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