Monday, December 21, 2009

Can your doctor read your mind?

There is considerable research being undertaken on new ways of communicating. And I don't just mean communicating with each other as we talk, sing, shout or cry. I mean ways of communicating with other objects, such as cars, computers and other electronic devices. I also mean communicating with people who are in other parts of the world, and who we may or may not know. And I also mean communicating with animals, with people who are deaf and blind, or who are profoundly physically or mentally disabled.

We all know of many examples of our unconscious mind seemingly taking over and informing us of events occurring before they do actually happen - we call it "déjà vue." I will never forget my first memory of this. I was watching a soccer game on television, and I suddenly "knew" that a goal was about to be scored in a certain way, by a particular player, and within a couple of minutes exactly what I "knew" happened.

There are many other examples of the unconscious mind influencing us, our behavior, or our decisions over the ages, and books have been written, societies and religions formed and history influenced on multiple occasions by the strength of our unconscious and the many unconscious or inexplicable communications that occur in our world.

But how will the power of our unconscious mind be influential in healthcare? And will it be somehow linked with the research on communication that is occurring around the world at this time? Will it occur in tandem with research that is trying to define our moods, and which uses electrical currents through our bodies to predict, for instance, suicidal intent?

Let's move to a more mundane form of communication. This article was written with the aid of a voice recognition system. I spoke into a microphone and words appeared on the screen, mostly accurate, but needing some corrections. I also now write my patients notes using a similar system - straight into their electronic records, which I can also control with the voice system. So we are certainly starting to use voice control systems in everyday life, even if they are not yet perfect. But what is the natural extension of these sorts of activities, and how might they be used in the field of healthcare?

We all know that we can communicate just by looking at people. We also know that we can tell what another person is thinking, particularly if that person is very close or important to us. I know that I and my wife often realize that we are thinking the same thing at the same time - and much more frequently than should occur just by coincidence, or because we are in the same environment.

So will be able to eventually use these extra powers of communication with our doctors? Will it be possible for our doctors to literally "read" our minds - to download our thoughts straight into our electronic medical records? It is certainly possible for humans to use their minds to control other objects, without even needing to talk. A number of experiments have shown that our electrical brainwaves can be trained and used to control other objects, be they an artificial limb, or a computer joystick, and these experiments offer substantial hope to severely disabled people.

I think the answer is certainly "yes". But with a caveat. This will not occur soon. And we will have to have considerable ethical debates before any such programs are introduced into clinical practice. But it should be possible. After all, a doctors primary diagnostic skill is pattern recognition - we see simple, and often unusual patterns in massive amounts of data collected from patients, and equate these patterns with a diagnosis. So why should we not be able to extend this often unconscious skill in pattern recognition to include the power to "read" our patients more accurately. All doctors know certain colleagues who are frequently regarded as superior diagnosticians who already almost seem able to do this. So I suspect that in future, as we discover more about the interaction between the mind, the brain and the environment, that we will develop physical means of "mindreading". I wonder how that will affect the doctor-patient relationship?

Peter Yellowlees MD has recently published "Your health in the Information Age - how you and your doctor can use the Internet to work together" - available at most online bookstores.

Thursday, December 3, 2009

Guidelines for videoconferencing in mental health

I am very pleased that the guidelines on videoconferencing in mental health published by the American Telemedicine Association are finally available. A large number of people contributed to these guidelines, but the core writing group for them was myself, Jay Shore MD, Lisa Roberts PhD, with a lot of input from a number of others, including Barb Johnston, who had worked with me on an earlier version published by the California Telemedicine and eHealth Center, and Brian Grady MD, Eve-Lynn Nelson PhD and Kathleen Myers MD.

Writing guidelines is an exhaustive process. It is not the sort of thing an individual can do, and requires input from large numbers of people, especially people with different perspectives. Unfortunately in medicine, it is rare to find a single view on a clinical process, and this was as true for these guidelines as it is for the many other sets of guidelines available in other areas.
I know that all the authors are pleased with the result here - for several reasons. First of all the guidelines are relatively short, usable and practical. They do not have the failing of many other guidelines that are 50 pages or more long, or only apply to a very specific group of patients or settings. These guidelines are really generic, and can be used by any mental health provider with any type of patient. They also have a lot of overlap with non-mental health areas, and would be usable, for instance, by providers in primary care, geriatrics and many areas of internal medicine. They also apply to adults, children and the elderly, as well as to emergency and non-emergency situations. And they have information about clinical, educational and technical issues and approaches - all in just a few pages. They are designed to be downloaded and could easily be taped to videoconferencing machines so that they are easily available for use "stat" by any provider undertaking consultations using videoconferencing. So let's hope that that is how they are used, and that they are helpful. It would be good if a number of the American specialist colleges, such as the American Psychiatric Association, and the the American Psychological Association, could adopt these guidelines for their own use, rather than attempting to rewrite them completely. Let's see if that happens.

In the meantime, I strongly suggest that, if you are a provider of mental health services, that you download a copy and go through it, so that you can undertake telepsychiatry consultations in the best possible way. The guidelines are available at the American Telemedicine Association.