In spite of the minor mishaps of my first week, outlined below, it has become clear to me that telepsychiatry can be a viable, valuable, and timely addition to our psychiatric lives and that of our patients.
Telepsychiatry, from home
I begin my first week of my new job as a full-time telepsychiatrist, working for the Green Bay VA Hospital in Green Bay, Wisconsin.
The basement, my new office, is far colder than I ever imagined. I have donned a Polartec® jacket for warmth. My fingers are tingling. I’m thinking of putting on a knit cap. When I turn on the electric baseboard heater, which we have never used in our 17 years in the house, things start to warm up.
Then, I sense the strong smell of something burning. Then, the fire alarm system goes off—not just in the basement, but throughout the house—after I had dutifully linked all the fire alarms in the house to go off at once! I hear the footsteps of my obviously startled son and his girlfriend, home from Texas, on the floor above me as the alarm wakes them. Fortunately, there are no open flames.
Later, while seeing a patient, I realize that there is a stream of warm air coming from the side of the laptop on the right side of my desk. Slowly I start to slide my hands towards the warmth as I talk, hoping to warm up my freezing fingers. I suddenly realize that the patient can tell I’m doing something with my hands, but he can’t tell what I’m doing, because my hands are outside of his field of vision. An awkward moment of silence occurs. I slowly pull my hands back towards me. Grist for the mill.
I must not look into the mirror very often. In a small window in the corner of my monitor, as I talk with my patients, there is some old guy who seems abnormally animated staring at me. Wait! That’s me, looking back at me! What happened? The last time I looked at myself, I had a lot more hair and I looked at least 15 years younger! This is not pleasant. I also notice that I have a tendency to lean towards my patient when I talk—something I was unaware of until now.
When I lean in on my telepsychiatry system, my head suddenly looms large and fills the screen that the patient sees. It must look like Shrek coming out of the woods. I consider whether my patients might enjoy having 3D glasses so my head will appear to bulge out into the room towards them. It might work as a sort of a Rorschach test, to better assess their startle response.
I’m considering writing a movie script, a sort of sequel to “Home Alone,” about a psychiatrist whose parents accidentally leave him home alone. (Wait, that won’t work!)
It’s frighteningly quiet here when I’m not seeing a patient. I think up a ruse, and call the nurse I used to work with, ostensibly with a valid question. I think she sees through me. She’s probably thinking: “Here we go. He’s been home alone for less than a week, and he’s losing it.” I’m fearful that she might be correct.
I’ve always known that interacting with other staff was a big part of my job satisfaction, but that fact is being driven home with painful clarity. I start flipping through the job ads at the back of Psychiatric Times. Prison psychiatry is looking like a viable option for the first time ever. At least there would be someone to talk with!
Dr Knoedler left his “Comfort Zone” job as Medical Director of Sheboygan County Health and Human Services in Sheboygan, Wisconsin. He is now a full-time Telepsychiatrist for the VA Hospital in Green Bay, Wisconsin.