Second Life in Physician Patient Relationships

In Dr. Yellowlees excellent paper regarding ethical considerations in mental health treatment in virtual environments he notes that the same laws and regulations must apply to the care or interaction, no matter what "environment" the care occurs in.

Dr. Yellowlees also finds there is very little difference clinically between telemedicine practice and virtual world therapy, but I have to say that in my limited time in the Second Life (SL) world I noticed several items that made me ponder that point.

To be "proficient" in SL at an Advanced level, I'm presupposing a long learning curve, which the patient must be able to accomplish. This requires intermediate computer skills at least, which obviously not all patients have. Are these less than intermediate level patients then exempt from therapy in a virtual environment? Telemedicine patients have only to respond to a human voice and image on a screen, an environment that requires minimal skill on the part of the patient as many are familiar with Skype, or certainly at the most basic level, television. Additionally I assume patients would need to be able to download the program, an ostensibly simple task that has caused me hours of frustration and necessitated the help of my hospital’s IT department (and it’s still not 100%, which causes me great consternation and makes me want to seek therapy in any environment I can get to!).

HIPAA considerations are a top priority in any patient interaction, and as Dr. Yellowlees notes in an “unprotected” environment like SL extra precaution must be taken. In my short time in SL I was amazed, impressed and ultimately kind of creeped out by the expertise of the SL residents I chatted with. All manner of acronyms and extremely creative visual images were displayed on the chat screen, using only the tools available on a regular keyboard. If they have the time, desire, and intelligence to format these images, imagine what they could do if they turned their talents to hacking the program and intruding on a private island.

Adding to the creepy factor, all of the avatars dancing in the blues bar I visited were…without clothing! Which led me to wonder… why? My avatar apparently was the only one who found it appropriate to dress for the occasion. I’m not sure but I don’t believe there are restrictions on language use (i.e. profanity), although surely there must a way to report inappropriate users.

All of the above was enough to make me somewhat uneasy with the physician/patient interaction in the environment, even though VOIP is used and no session records are kept in the application. I’m confident my opinion will change if I’m able to hold on to my connection and participate in the seminar tomorrow evening.