Craig Chepke 博士，CURESZ 基金会董事会成员，私人执业精神科医生和北卡罗来纳大学医学院精神病学兼职助理教授

March 2021 marks a year since the United States declared the COVID-19 pandemic a national emergency, and the healthcare world is still trying to sort out the details. In an instant, telemedicine went from being a niche service to a baseline expectation for healthcare providers in every setting, from large healthcare systems to private practices.

与许多其他专家不同，大多数精神科医生不需要大量设备来完成我们的工作，因此人们会认为该领域是顺利过渡到远程医疗的理想选择。然而，许多精神科医生非常不情愿地这样做——包括我自己。在我生活的几乎每个方面，我都是我能接触到的每一项技术的狂热用户。然而，在我的临床实践中，我坚持面对面的预约和手写我的笔记，以尽可能保持眼神交流。但危急时刻需要危急措施，所以我一夜之间成了临时的远程心理医生。早些时候，我从同事那里听到了两个共同的担忧：精神分裂症患者难以使用远程医疗所需的技术，或者妄想或幻觉会严重影响约会。

My experience, however, has been different. On the whole, I’ve found people with schizophrenia to be very comfortable with navigating technology. More troubling has been the so-called “digital divide,” which refers to the fact that not everyone in the country has equal access to fast, stable Internet connections and adequate hardware to take advantage of it. I have also not seen psychosis present a source of problems that would not have been equally challenging if the person was in the same room. However, it can be more difficult for a clinician to assess the scope and severity of psychosis virtually, so I’d recommend patients try to be more proactive with voicing the symptoms they’re experiencing. Many people also find it helpful to make a list of topics they want to discuss ahead of time. Of course, schizophrenia is so much more than just the positive symptoms. I have noticed that some people who have more prominent cognitive symptoms of schizophrenia have been somewhat more distracted. On the other hand, many people with more prominent negative symptoms seem more at ease in our virtual interactions than face-to-face.

Telemedicine has also shown usefulness as a supplement to in-person care rather than a replacement. A dilemma for people who are prescribed Long-Acting Injectable antipsychotics (LAIs) in the pandemic has been that they absolutely require in-person administration. I believe that LAIs are life-saving interventions, so I had to figure out how to continue offering injections while doing my part to keep everyone healthy. Early on, I transitioned people to LAIs that can be injected in the shoulder to allow people to drive-up and receive the injection while remaining in their car. As we gained confidence in our ability to use masks and distancing to reduce infection risk, I started to bring people who need LAIs administered in the hip muscle back in the office to do so. After I administered the injection, we conducted the remainder of the visit virtually to reduce the chance for transmission of the virus.

远程医疗的广泛使用也带来了明显的积极影响。旅行时间的消除使人们更容易安排与其他义务相关的约会。因此，当人们急需预约时，我能够更快地安排他们工作，远离办公室的人能够安排更频繁的会议，并且错过约会的次数也有所减少。远程医疗还使人们能够超越当地地理范围寻求专科护理。居住在农村地区的人们比以往任何时候都更容易获得全州或其他地区精神分裂症专家的治疗或第二意见。

他们说需要是发明之母。虽然过渡的紧迫性导致我们犯了一些错误，但临床医生和患者都很快适应了。结果以一种我认为我们不会放弃的方式改变了医疗保健。无论远程精神病学最终是什么样子，有一件事是明确的：它是某种形式的医学的未来。