At the Kartini Clinic we are grappling with the concept of providing our patients with tailored aftercare treatment at a distance.

Why? Many reasons: sub-specialty eating disorder treatment does not exist in all communities, in fact it is rather rare; with all the transportation involved, parents often lose a whole day’s work to get their child to outpatient eating disorder visits and children lose a day of school. During winter it can be dangerous for patients and/or their parents to drive long distances to reach us; older kids go off to college!

Dr Moshtael and I were raised in a culture of medicine where “telephone medicine” was considered “bad medicine,” and in some clinical settings it definitely still is (e.g. prescribing antibiotics over the phone for a feverish baby, without an examination). But as technology has changed everything, including—reluctantly—medicine, we have begun to reconsider distance aftercare treatment.

Obviously it remains critical to assure quality and safety. So how to do that? For starters we will only offer distance aftercare to established patients whom we know and whose family we also know. This allows us to do distance-family therapy, teaching, and coaching via video Skype; it also allows our doctors to work with local physicians in a family’s home town, to monitor weight, vitals, any labs, and food intake; individual therapy would also be possible using Skype. And Skype is both simple and free.

Sounds great, doesn’t it? But there are considerable hurdles.

Neither the law nor insurance companies have caught up to the digital age. Insurance routinely does not cover this kind of distance medicine and families would likely have to pay privately. This would, to some extent, be ameliorated by the reduced need to take time off work to travel to us, but it is still a consideration for many.

More problematic yet is the fact that, for the purposes of telemedicine, every state requires a doctor or therapist to have a license in the state where the patient resides, rather than the state where the provider practices. And since it would be too complex and expensive (not to mention take forever) for all of our doctors and therapists to be licensed in all states, for the moment this option remains confined to Kartini families residing Oregon and Washington and our patients from overseas.

But we remain open to thoughts, suggestions, recitations of experience… what does everyone think?