Internet camera communication is being used for a wide variety of purposes —  from business conferencing, to military families with deployed loved ones, and yes, virutual sex, but will video visits with your doctor substitute for face to face visits?  Virtual visits to your doctor could improve efficiency and access for both the doctor and the patient.  http://abcnews.go.com/Video/playerIndex?id=7530334

Dr. Olson appearing on "Bringing Back the House Call, Virtually" ABC News, Good Morning America

            Some possible uses for video calling with your doctor:  

• Introductory visits
• Follow-up where a physical examination is not required, eg. Reporting lab results, refilling routine medications
• Consultation with specialist with limited availability

            Although we have more psychiatrists per capita in the U. S. than any other country, 50% of those with significant depression cannot access psychiatric care. The important book, Crisis, http://www.crisisbook.org/ relates the stories of forty gay men and women who have struggled with the conflicts of coming out as young men and women, but the problems of older men who have sex with men, particularly those who do not self-define as gay, is rarely discussed except in sensational headlines as someone’s secret life is exposed.   

            These men, who often live hidden lives, are also at great risk for depression, alcohol and drug abuse, and sexually transmitted diseases.  A video call might allow access for them to an otherwise unavailable, gay-supportive health care provider.

            Although video calling is frequently used for anonymous virtual sex, these contacts, just like contacts in the real world, can lead to intimate personal relationships that are based on friendship rather than sex.   While some men are seeking only a quick orgasm, others are finding access to a diverse group of gay men who have struggled successfully with this conflict. 

            While cam to cam counseling may not be as good as face to face consultation, it may offer be the only alternative available to some men.  Where it has been used for counseling, acceptance has been high.  Insurance companies usually deny payment for these visits, but the costs may be offset by less time from work.

1. Dave UK says:

   November 17, 2009 at 2:39 pm

   I live in the UK and this is the first time i have heard of using skype or web cams to consult with a Doctor or any other clinical professional.

   You mention that 50% of people with depression are unable to get psychiatric care, I’m not sure if this is because they can’t afford it or they avoid it because of the one on one interaction required.

   I myself have suffered with depression and am at present seeing a psychiatrist, although it is hard to talk openly with someone, I fear if i had the option of doing it on Cam, it would not help me overcome some of my problems, although it would be nice to talk with friends, as a social aid i think Skype works really well also to speak with your Doctor if you are unwell in a physical sense, but for emotional issues.

   Im going to continue with the physical face to face despite how hard it is for me at times.
2. Loren A. Olson M.D. says:

   November 17, 2009 at 7:32 pm

   Thanks for you comment. The 50% I am talking about are those people who either don’t have insurance or can’t find services available even with insurance.

   Psychotherapy is hard work. It is frightening to tell someone things which sometimes are almost to frightening even to think to ourselves.

   I don’t think doing Skype or other forms of telepsychiatry is ideal, but it can work in some circumstances. Psychiatrists tend to concentrate in cities. It can allow them to be in several locations on the same day, broadening access. Traveling can mean a lot of time behind a windshield, time which could be better used serving patients.
3. Doug Ikelheimer, MD, MA says:

   November 19, 2009 at 2:41 pm

   I believe it is inevitable that Skype telepsychiatry will become widespread, even in (or especially in) the urban setting. It is cheap, green, and effective and if done properly, it entirely meets standard of care of traditional outpatient psychiatry.

   I have been advocating for this for a number of years and I published a Letter to the Editor of Psychiatric Services on this topic in October of 2008. See

   http://psychservices.psychiatryonline.org/cgi/content/full/59/10/1218-a
4. Loren A. Olson M.D. says:

   November 19, 2009 at 5:01 pm

   Thanks for you comment. One of my colleagues in Iowa, goes to Arizona for the winter, and continues to follow patients in Iowa. As winter gets closer here, that begins to look better and better.