Defending Telepsychiatry

To the Editor: I disagree with the pessimism expressed by Werner and Anderson in their article on telepsychiatry in the October 1998 issue. We began developing telemedicine at Cedars-Sinai Medical Center in Los Angeles several years ago and are running a very successful and financially viable program. Several things differentiate our program from the one reported on:

•We provide a very specialized consultation, psychiatric evaluation of individuals with severe developmental disabilities. We do not see general psychiatric patients.

•We function as consultants, not as primary care providers. Our patients are followed up by local nonpsychiatrist physicians.

•Because of the number of people involved at both the Cedars-Sinai site and the local telesite, we use the consultations as an educational opportunity for the local treatment team as well as for our residents.

•Each clinic session is two hours long. Most relevant information is sent from the local site by priority mail beforehand, at $3 a package. Progress notes are faxed immediately. In follow-up visits, a group home progress note is provided before the session so time can be used maximally.

•We use a 32-inch screen TV, which permits an excellent direct evaluation and mental status examination.

•During the sessions, the patients at the local site are placed next to ancillary staff who know them well, facilitating optimum direct evaluation.

I do agree that general psychiatric direct care may not be feasible and that telepsychiatry may best be reserved for subspecialty consultation and education.

Dr. Szeftel is director of child and adolescent psychiatry and director of the child and adolescent psychiatry fellowship training program at Cedars-Sinai Medical Center in Los Angeles.