Saturday, May 02, 2009

Unusual Treatment Settings

A psychiatrist colleague is learning to do Cognitive Behavioral Therapy. He's treating a patient with agoraphobia, and goes to the patient's home to work with the patient on slowly coming out of his comfort zone.

It got me thinking about treating patients in their homes, or in places other than the office.

I've been to the homes of patients a few times-- none were my on-going therapy patients. As a resident, I rotated through an Outreach Team. These teams provide treatment to people with severe and persistent mental illnesses who have a history of non-compliance-- these patients don't keep their appointments, and they repeatedly get sick and end up in the hospital, sometimes many, many times. As the doctor on the team, I never went alone, always with a nurse or social worker who knew the patient, and mostly I was an observer. It was a great experience. As a clinic medical director, I went with our case manager a few times to see patients she was worried about.

So I'm thinking about the colleague who visits the patient in his home to help him negotiate the world. Is this a feasible way of treating people? The psychiatrist stays for an hour, and there's transportation time (I don't know how long that takes) financially, this could be an expensive endeavor. In this case, I believe the doc is salaried, and the patient is being seen pro bono as part of the learning experience. And what about the boundary issues involved in being in a patient's home?

I'm writing without really having a point I want to make. Does anyone else do Home Visit Psychiatry and what thoughts can you share?