The new couch

BAXTER - A severe shortage of psychiatrists in rural Minnesota is getting a dose of telemedicine.

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At Nystrom & Associates in Baxter, technology is playing a key role in getting clients in front of a psychiatrist via a big- screen TV. The life-size live image on the television screen links the psychiatrist in New Brighton offices to clients seated in a room in Baxter. It's real time. The technology allows a flow of conversation between the two cities where both parties can talk to each other freely and view each other's image. The movement and speech is clear.

Sue Vanek, Nystrom & Associates office manager in Baxter, said people who have tried it are embracing the telemedicine connection, which reduces wait times. Psychiatrists can write prescriptions and have them printed in the Baxter office. Without the telemedicine, Vanek said people are faced with waits or traveling to doctors. Child psychiatrists are particularly scarce.

"The drive is getting farther and farther away for people in this area to find providers," Vanek said.

Sarah Simonsen, physicians assistant in New Brighton, talked with Sue Vanek, Nystrom & Associates office manager in Baxter at Nystom's offices on Evergreen Drive via a large screen television as part of the offices expansion into telemedicine so clients have greater access to psychiatrists.

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Clients come in an hour before an appointment and information - such as symptoms, histories, goals and self-evaluations - are scanned and sent to the doctor for review before the "face to face" meeting.

Sarah Simonsen, physicians assistant in the New Brighton office, said the approach to the session is basically the same as if it were in-person.

"I can't read facial expressions as well as I'd like," Simonsen said. She was apprehensive about the telemedicine at first but said overall patient response has been positive. Clients with social phobias may even find the telemedicine option initially more comfortable. By using the screening information, the session can focus on symptoms the client is dealing with.

"I feel like I'm actually talking to a person live," Simonsen said. She asks for clarification more as a way to balance not having the non-verbal cues as detailed as they would be if the two were physically in the same room. But Simonsen said for care this is the next best option.

"I was able to communicate with them as I would in person," Simonsen said. "I'm actually enjoying it quite a bit. I see this as a great service to provide care for people in more rural areas."

There are schools of thought that the future of medicine may include telemedicine portals at home one day where patients can speak with their doctors without setting foot in a waiting room. Simonsen said there is a concern that it may be too impersonal but by the end of the telemedicine sessions most people feel comfortable.

Simonsen said the technology has been smooth and Vanek added the move to electronic medical records has made the process even easier when exchanging information between providers to streamline patient care. Clients dealing with paranoia may have more challenges with trusting the technology.

The technology supports two high-definition flat panel screens, Internet and IT support, costing $10,000 to $20,000 for a unit. The connection has been reliable, particularly with high-speed Internet.

Dr. Jonathon Uecker, pychiatrist and medical director at Nystrom & Associates in New Brighton, worked to set up the telemedicine protocol. From the New Brighton office, Uecker said it is harder to establish rapport and convey warmth and empathy through utilizing the telemedicine option. Since good eye contact is more of a challenge, the doctor has to work harder to let the patient know they are being heard, Uecker said. Doctors using telemedicine need to be more active and more verbal.

With medical school graduates saddled with heavy student loan debt, Uecker said decisions on practicing in the metro areas come down to income and a health care system that awards physicians that are procedurally based and penalizes those working in cognitive fields. Changing how doctors are reimbursed is one answer, Uecker said. Another consideration for doctors is the pressure of being the sole psychiatrist in a rural area where they are the only specialist and thus on-call continuously.

Regarding telemedicine, Uecker said he tells people it feels a little "quote unquote weird but it does offer a definite advantage in terms of access."

In Duluth, the wait to see a psychiatrist may be three to four months. With telemedicine, that wait can be reduced to about one month. Getting more psychiatrists to stay in state is one goal and allowing medical student graduates to use telemedicine service for tuition waivers may be another option to increase the services, even if those doctors stay in a metro setting.

Vanek said telemedicine is accepted by insurance providers.

Uecker can visualize a time when a doctor consultation may be available via laptops for both physician and patient, making health care more accessible. While there are times when a physical exam is required, for psychiatry the exam is more about talking to the patient.

"I think in terms of the care delivered, it is equal to having someone there," Uecker said.

RENEE RICHARDSON may be reached at renee.richardson@brainerddispatch.com or 855-5852.'