“AFAT” is an acronym I coined myself and it stands for “Atom Fool Around Time.”

The idea behind this acronym comes from a book by Nicholas Negroponte written in 1995, called “Being Digital.” Negroponte’s book was, and still is, completely on the mark with regard to understanding how the Internet has changed and will change our world going forward.

Negroponte starts with a simple distinction. Most of what is important to us in the world is either something that weighs something (“atoms”), or something that weighs nothing, like information (“bits.”)

Houses, people, chairs, and nose rings are atoms; Music, books, almost all money and the map in your GPS are all bits. Now, to be sure, something like a printed book weighs *something*, but the essence of a book isn’t the paper it is printed on, but the information that it contains. I would argue that my copy of The Lost Symbol on my Kindle is just a much a real copy as the one on sale this week at Walmart. Take your favorite music CD and break it in half. It still weighs the same, but the music is gone–the information that makes the music play weighs nothing.

Weightless bits fly through the Internet to me at close to the speed of light and cost essentially nothing to transport; Atoms come to me by cars, trucks, airplanes, ships and trains and cost real money to move from one place to another.

This is a long winded introduction to what I think telepsychiatry’s greatest advantage is over face-to-face communication. When a patient and I see each other we are usually exchanging information, not atoms. If the most important thing is information, then does it really make sense for the patient to fool around with hauling his or her atoms to come see me for every visit? I don’t think so.

I’ve already made it clear that atoms can be important, even vitally so, but is equally important to notice that seeing people face-to-face rather than via a videocall has big transaction cost which seems to be unnoticed by many people: To have a face-to-face visit, the doctor or patient or both have to drag their atoms into proximity to each other. This has a cost, just like it costs Amazon thousands of times more money to send me a physical book than to send some bits to my Kindle. The transaction cost of a face to face visit is not just gas, parking fees, office overhead and the risk of a car accident. There is also a psychological cost. At times the streets outside my office are jammed with cars and patients come in late and stressed. Sometime their car breaks down. Sometimes they are late to pick up their kids at school. Sometimes they miss something else because of their commute time.

I spoke to a colleague last week who told me clearly that he could see no reason for telepsychiatry and thought face to face was always better. He works in a location which is hard to drive to, expensive to park at, and staffed by so many poorly paid and surly employees that one of  my other patients refers to this place as having a “patient prevention plan.” My colleague can see the possible disadvantages of something new like telepsychiatry, but can’t see any of the costs that he and his patients incur by his belief that only face to face contacts could work to help his patients.

AFAT has a big cost, it’s just that most people don’t see it. Telepsychiatry eliminates a lot of AFAT. That’s why there”ll be more telepsychiatry in the future.