The Coronavirus Has Changed My Psychiatric Practice Forever

Yes, my cozy home office is now, and will continue to be, where I practice psychiatry. Even after I get a proven, effective vaccine, my 13” iPad will continue to be my interface with patients. It is not perfect, but it’s more than pretty good. It works well, and the advantages compensate for the deficits.

For most of my career I had a government position, but always maintained a small private practice. After I retired from my last public job several years ago, I expanded my private practice, but continued to be office-based. That pretty much put a geographic limit on who could see me. That limit is now gone. That’s an advantage.

But I’ve gotten ahead of myself. Until March of this year I never imagined giving up my office and working from home via a computer screen. Then the coronavirus hit: everyone was plunged into a life-changing reality in a matter of days. I vacated my office so quickly that my personal possessions were left behind: I did not go back for them until mid July. But within a day I learned how to connect electronically, and there was very little disruption of therapy.

What is therapy like now? One difference is that I can no longer see the whole body; the face takes up the whole screen. Now I see the face two or three feet from my eyes instead of six or seven feet away. I see flickers of the eyes and twitches of the mouth more easily than I did in the office. It’s a trade-off, because I can't see anxious tapping of feet or wringing of hands. Importantly, my patient can see me in exactly the same way, and some have commented that they like seeing me close-up.

Disadvantage: I can’t observe how the person enters the room, sits down, or leaves.

Advantage: I see the person in their home, the room in which they decide to sit, the chair they choose. I may learn something from the background sounds and the interruptions

Almost all of my patients tell me that they like the current arrangement. They enjoy the time they save driving to the office and back. They can return to their lives as quickly as they wish after our session ends. They feel secure in their home, as they speak of painful matters.

Another development: some patients who had completed treatment have come back because of the stress brought on by the coronavirus. A few have come for one or two remote visits, just to be reassured that I am still around and available. One has re-engaged in therapy.

Twenty or more years ago, I joined a peer support group. We rotated meeting at each other’s offices, we regularly got together one Friday a month for a two-hour brown bag lunch meeting. We have not met as a group since March, but we keep in touch. Over the phone the seven of us have agreed that we really don’t want the risk of going back to the office while the virus remains a threat. But beyond that, looking forward, our comfort and our patient’s satisfaction with this arrangement will keep us in our home offices. We will probably resume our peer group using Zoom.

Every medical and health care specialty is grappling with the issue of office visits versus screen visits on a case-by-case basis. At the ‘must see in the office’ end of the spectrum may be dermatology: skin lesions must be seen, evaluated, and perhaps biopsied in the office. My orthopedic surgeon is in the middle; he was able to evaluate my knee on screen. Physical therapists are experimenting with virtual reality. Psychotherapists may occupy the screen end of the spectrum. So far, it has worked well for my colleagues, and for me.