1217 Miles

As part of my work as a psychiatrist, I did a stint in Telepsychiatry. This is providing psychiatric care via Skype, to those in need, to individuals who do not have physicians that are easily accessible. Montana, called ‘Big Skype Country’ in jest, is one of those places.  There is a major shortage of physicians there and I was recruited to see patients via computer in an outpatient facility in Montana.

I received my license to practice medicine in Montana after a few months. my laptop was programmed to see patients and made HIPPA compliant (the Health Insurance Portability and Accountability Act, for protecting sensitive patient data). I removed all of my Brett Favre and Green Bay Packer photos from the wall and replaced them with my medical diplomas to serve as a more appropriate Skype backdrop as I sat at my desk at home.

I was skeptical. Would I be able to “connect” with my patients, to recognize all the subtle nuances that are so crucial to diagnose and treat patients? As psychiatrists, we have no blood tests, procedures or sophisticated means to make a diagnosis. We rely on self report, on our own perceptions and clinical judgment.

The experience montanathere was fascinating and I feel like I really made a difference. Instead of driving for 3-4 hours or waiting months for an appointment, they came to me. I wrote this poem to convey my thoughts about my work there.


1217 Miles Between Us


Strangers facing each other
On a screen.
A leap of faith
taken by both sides

Many have never seen
their reflection on a computer screen,
They are reassured.
She is there,
You just cannot touch her.
They talk.
Asked about what they eat,
how they shit and
how they sleep.
Asked about
alcohol and drugs.
work and
They talk and
the barriers of miles fall.

Grizzlies, black bears, floods and spiders.
And ‘green cards’,
their psychiatric diagnosis
a license for medical marijuana.
Extolling the merits
of Mary Jane,
to calm shattered nerves.

In the end of the day
it is love and work.
Love and work.
Not enough of either, or too much work
1217 miles
and yet,
Love and work
unite us
as the central theme.

40 minutes later
we part.
They marvel at the technology,
in their own ability
to open up.
To a total stranger.
Twelve hundred

Written by Anne Koplin, MD