Internet Presents Mixed Blessing For Psychiatric Practice

The practice of medicine today already includes extensive Web-based activity, according to Nicolas P. Terry, LL.M., a professor of law and codirector of the Center for Health Law Studies at St. Louis University. “Syndication of publications; CME activities; services such as Medem.com, which offer business-to-business (or ‘B to B’) services to construct for physicians a business-to-consumer (or ‘B to C’) interface; procurement activities; and portals of information such as Medscape.com, are very active and vital parts of internet based healthcare today.” Not to mention, Terry said, all the “background” activities of processing of paperwork, including electronic processing of patient records and insurance claims.

According to Terry, the possibilities of electronic communication are endless. For example, technology will one day allow people at home to walk into their bathroom in the morning and, instead of simply stepping on a scale to check their weight, interact with an integrated system with a permanent online connection. The new device will give them a complete checkup, Terry predicted, and transmit the data to a physician database. By lunchtime, people will have received e-mail via their personal organizers that tells them what they can eat for lunch.

“If it seems far-fetched, folks, the technology already exists,” Terry concluded. “Its wide availability depends only upon increasing 24-hour-a-day, seven-day-a-week broadband access to each person’s home. A little-known company called Panasonic is currently conducting clinical trials on machines that can interface with a doctor module and provide just these types of services.”

With regard to e-psychiatry, Terry said to “keep your eye on telepsychiatry and Web help.” Videoconferencing already allows remote sessions to occur, and soon Web-based counseling and therapy will be common, he said.

With the rapidly advancing technologies in the next few decades come significant legal and ethical challenges, Terry said.

The most important legal questions will surround licensure and jurisdiction. For example, will doctors be able to practice across state lines using the new technologies? “Secondly, the idea of malpractice will have to not only be expanded but also perhaps totally redefined.”

“The real key here is that the patient-physician relationship will totally change,” Terry suggested. “E-health will deliver information, diagnosis, treatment, care, and prescribing in a nonlinear, nonhierarchical way. It will allow patients to enter the mental health system at far more points than they’ve ever been allowed to before. And that mode of entry and creation of new relationships basically does an end-run around most of the regulatory systems that we’ve set up over the past 200 years.”