I was born in 1949, the second World War had been over for a mere four years.  As a girl raised in the 50’s and 60’s I was taught to read books, wear dresses, skirts and pinafores, and to sit still.  As long as I had a book the sitting still was no problem.  And I always had a book.  At sixteen I participated in the American ritual of learning to drive a car, and never looked back. At eighteen I went to college and sat in class with everyone else, my class choices limited by what was offered in our particular university’s “course catalogue”.  The choice did seem immense. I went to Reed College with a slide rule and exited medical school with an early calculator.  I saw my first electron microscope at OSU one summer—it took up an entire room, just like the early computers I had seen my older friends sign up to use at Stanford, where I grew up.

As I am a writer and always have been, when my brother-in-law showed me how to use his IBM personal computer (DOS, slow and incredibly non-intuitive) to write the text for a novel I was working on, I was blown away.  The simple expediency of word processing made me forever put away my #2 pencil and eraser, as well as the multi-lingual typewriter my parents had given me for graduation from high school. (I still have the darling thing, now a modern museum piece). I quickly discovered Steve Job’s Apple computer, in my opinion a giant improvement over my brother-in-law’s IBM.  

As a young doctor we had pagers (long before the drug dealers did), and it became routine to dive off the freeway and beg the use of some store’s landline when you were “on call” and the pager went off, or to drive around slowly looking for a pay phone.  When cell phones came along, and large, attached car phones, it was a game changer for us doctors.  We could be reached and respond to questions without leaving our car or our restaurant or our birthday party.  Our call-night phone calls (as a pediatrician in the winter we could easily get 50 sick calls a night) no longer had to immobilize the family phone.  No more yelling at the kids “Stay off the phone!! Mom is on call!!” I have included a photo below of my granddaughter, one I call “Mommy, what’s this?”

I think you know how all of this has changed.  Never mind that girls can wear whatever they want now, and that books are receding into the past in favor of electronic devices which can be equally imaginative.  Never mind that I can take an online (free) course from Stanford or Yale while enrolled in the local community college-- or not enrolled anywhere at all. Never mind that computers more powerful than the room-sized ones at Stanford of yore can now fit on your eyeglasses or wrist and that cars will soon drive themselves… It was a fast train we had stepped on, but no one knew how fast.

Technology has changed our lives already: the good, the bad and the ugly. And it has changed medicine. Profoundly.  How profoundly we are just beginning to find out.

This brings me to the topic of virtual medical visits, something I hope readers will chime in on here, since this will affect ALL of us, and how it comes down is something we will, each of us, want to be a part of crafting.

I do not want to talk about how phone/skype/tablet visits affect general medical visits for sore throats, etc, .although that is important.  I want to talk about how they can/could change and improve the treatment of children with eating disorders, especially at Kartini Clinic.

Family-based treatment, as we practice it at Kartini Clinic, is very demanding for parents.  Ignoring inpatient and partial hospital levels of care for a minute, let’s focus on meaningful outpatient follow-up and initial diagnosis.  

How could these interventions be made easier for parents and still maintain excellent outcome, which is the whole point of the exercise?  What if you, a Kartini parent, could email us your child’s food journal for the week(s) and then “meet” with us virtually (a “conference style” skype? Some other more advanced method?) from your tablet or other device?  

Imagine that you were on your tablet at home, your spouse was on his/hers at the job (where they had received a text “the doctor will see you now”, stood up, closed the door, or stepped into a quiet room off the production floor) and your child had reported to the school nurses’ office for this “appointment”.  No more taking the afternoon off work to drive across town and pick up your child, no waiting in the doctor’s office (fuming) for ten or even sixty minutes of the doctors’ or therapists’ time.  What if you could have your mother-in-law in Seattle who had been repeatedly asking you why your child doesn’t “just eat”  join your session where they could learn about eating disorders from your team?  What if you could check in on your child’s progress in PHP/DTU by logging into a secure camera placed on the unit which scanned the room where they were receiving treatment (obvious legal/privacy issues to be addressed)?

Which are some of the interventions we perform that could be meaningfully improved for families by having them done virtually?  I hesitate to say “ask a twelve year old”, but it is true that we adults are limited by our own imaginations and experience and may find it hard to “think different” here.  What would help you navigate the demands of treatment?  

So these few things I have suggested would be good for established Kartini patients and their families.  But how about those families I hear from all the time who have no up-to-date treatment available to them in their area?  Finally insurance companies are getting with the program and offering to pay for some virtual visits, so how might we serve families at a distance and yet preserve an adequate—no, excellent—quality of medical care? Could parents have an initial (virtual) assessment with our intake physician, before they made up their mind to bring their child in for a definitive physical assessment?  That would certainly turn our three hour evaluation appointments into something more manageable, given the demands of work and school and distance.

Other ideas?  We are inventing this as we go along, folks, all of us.  It’s a good time to chime in.