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EDUCATIONAL COMPUTING | September 01, 1999

Psychiatry and the Internet: Q&A With Dr. Robert Hsiung

Thomas Kramer, M.D.; Robert Kennedy, M.A.

Academic Psychiatry 1999;23:171-173.

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Educational ComputingWeb SitesHsiung, Robert

Dr. Kramer is Assistant Director of Training, Arkansas Mental Health Research and Training Institute, Little Rock, AR; and Mr. Kennedy is Director of Fellowship Training and Director of Computing Services, Department of Psychiatry, Albert Einstein College of Medicine, Bronx, NY. Dr. Kramer's e-mail address is: tamkmd@aol.com. Mr. Kennedy's e-mail address is: kennedy@aecom.yu.edu.

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Abstract

We have another guest fot this issue's column. Robert Hsiung, M.D., is Assistant Professor of Clinical Psychiatry at the University of Chicago, and with his "Dr. Bob" Web sites, among others, has established himself as one of the leading psychiatrists active on the Internet and the World Wide Web. Many, if not most of us, have taken advantage of the resources he has created online, and know of his presentations at American Psychiatric Association annual meetings and other forums. We asked Dr. Hsiung three questions about psychiatry and the Internet. His thoughtful responses follow. We hope you enjoy this Q&A.—Thomas Kramer, M.D., and Robert Kennedy, M.A.

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Dr. Kramer and Mr. Kennedy: What do you see as the major resources of the Internet to the practicing psychiatrist?

Dr. Hsiung: What the Internet does best right now is provide information. There's a ton of information online that can be of great use to practicing psychiatrists. Here's one way to categorize these resources, with some (perhaps idiosyncratic) examples.

1. TRADITIONAL LITERATURE

Increasingly, traditional journals are moving online. The British Medical Journal was one of the first. The American Journal of Psychiatry has recently followed, but it will only be available free-of-charge through this summer. You can perform online searches of the traditional literature through the various MEDLINE sites. The one that's the most complete is probably PubMed at the National Library of Medicine.

http://www.bmj.com/all.shtml

http://ajp.psychiatryonline.org/

http://www.ncbi.nlm.nih.gov/PubMed/

2. REFERENCE MATERIAL

This includes, for example, treatment guidelines; both those of the American Psychiatric Association and the "Expert Consensus" series are online. There is also information specifically intended for patients—or for psychiatrists to give to patients. When I want to educate a patient about a medication, I usually provide some printed information, but I also offer a list of Web sites. Drug information from the US Pharmacopeia can be obtained from InteliHealth at Johns Hopkins. My "Student Counseling Virtual Pamphlet Collection" is a directory of educational material produced by university student-counseling centers located literally around the world. With the advent of improved data compression and transmission technologies, multimedia is becoming more prevalent. Our Grand Rounds visiting-lecture series at the University of Chicago, for example, can be listened to and watched live over the Internet.

http://www.psych.org/clin_res/prac_guide.html

http://www.psychguides.com/eks_gls.htm

http://www.intelihealth.com/IH/ihtIH?t8124

http://scrs.bsd.uchicago.edu/vpc/

http://psychiatry.uchicago.edu/grounds/

3. INTERNET RESOURCES

Here, I'm referring to resources that exist only on the Internet and aren't just online versions of information in print. Psychopharmacology Tips, another site I've developed, provides practical psychopharmacological information, culled from Ivan Goldberg's psychopharm mailing list (see below), on over 400 topics. There are also publications that are only available online. A good example, one in the news lately because George Lundberg just moved there from JAMA, is Medscape. Another category of Internet resource is put together by patients rather than physicians. One of the first of these was Pendulum, started by a group of bipolar patients.

http://dr-bob.uchicago.edu/tips/

http://www.medscape.com/

http://www.pendulum.org/index.htm

4. FRINGE ELEMENTS

One the Internet's advantages is that just about anyone can create a Web site. But that's one of its disadvantages, too: information online can be outdated, biased, misleading, or just plain wrong. As Silberg, Lundberg, and Musacchio warned in their JAMA editorial, "Caveat Viewor—Let the Viewer Beware." I think that resource providers who take their role seriously will assume some responsibility for educating their "viewers" about this. To practice what I preach, I've recently created a "quality of information" page, with links on this topic. A related issue is information that's accurate, but could be misused. One example of this is "‘How-To’Books: the latest in ‘self-deliverance’ publications."

http://www.ama-assn.org/sci-pubs/journals/archive/jama/vol_277/no_15/ed7016x.htm

http://dr-bob.uchicago.edu/quality.html

http://www.rights.org/deathnet/open.html

5. VIRTUAL COMMUNITIES

There are resources that emphasize interaction more than information. Interpsych is a group of mailing lists (sometimes called listserves) that focus on different aspects of psychiatry such as psychopharmacology or child psychiatry. Behavior OnLine offers a variety of specialized bulletin boards featuring experts in those areas. Psycho-Babble is a bulletin board of mine for mutual education and support, frequented mostly by patients. At Concerned Counseling, there are different "real-time" chat rooms, again used primarily by the public.

http://freud.tau.ac.il/haimw/inter.html

http://behavior.net/index.html

http://dr-bob.uchicago.edu/babble/

http://chat.concernedcounseling.com/

6. ONLINE THERAPY

Right now, the cutting edge of psychiatric use of the Internet is online therapy. It's controversial, but it's being done. Metanoia has a directory of providers (and a lot of related information).

http://www.metanoia.org/imhs/ongoing.htm

Dr. Kramer and Mr. Kennedy: What is the future of the Internet and psychiatry?

Dr. Hsiung: People usually end up embarrassing themselves when they try to predict the future. But that doesn't always stop them. In the future, even more information will be online. When people want to find out something, the first place they'll think of looking will be on the Internet. Since the Web is, after all, world-wide, geographical differences in practice will diminish, and we'll be closer to that "global village" that we've all been hearing about for so long.

Use of the Internet will be more integrated into everyday clinical practice. This is already starting to happen. Yesterday, I met with a patient on fluoxetine who's going to relocate to Turkey. After our session, I posted a question on the psycho-pharm list asking if fluoxetine was available there, and I've already received several affirmative replies.

Today, I had a patient report bruxism from sertraline, and I took a moment during our session to look up the topic in Psychopharmacology Tips and was immediately able to propose some treatment alternatives.

Telepsychiatry will become commonplace. Some treatment will be completely online, maybe especially in underserved areas or with avoidant patients, but more common will be psychiatrists and patients using the Internet to stay in touch when one or the other is out of town or for some other reason unable to come to the office. Some of these contacts will be real-time text-based chat; others will involve videoconferencing (i.e., real-time audio and video).

Office management will be more automated. Appointments will be scheduled online. Bills will be issued and payments will be made online. Medical records will be available online. And the storage and transmission of all this information will be secure.

Oh, what a glorious world it'll be!

Well, maybe not completely. Having more information available will mean more to keep up with. Patients will have access to almost as much information as psychiatrists, so the "playing field" will be more level. Documentation will be better and more accessible, but will include that of substandard care, so we might see more malpractice suits.

Dr. Kramer and Mr. Kennedy: What are the current impediments to psychiatry using the Internet more effectively?

Dr. Hsiung: Information overload. Information of questionable quality. Anxiety about confidentiality. Societal norms evolving more slowly than technology. Technophobia. Not being able to touch-type. Resistance to change—or, looked at the other way, treasuring the past:

The world is changing,

and we change with it.

The more we allow our minds

the romantic luxury of treasuring the past

in memory,

the less able we become to face the future

and to determine the new values

which can be created in it.

Edgard Varese, Santa Fe, 1936

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Thomas Kramer, Robert Kennedy; Psychiatry and the InternetQ&A With Dr. Robert Hsiung. Academic Psychiatry. 1999 Sep;23(3):171-173.

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