Digital psychiatry does not mean that all consultations should take place by video. For some people, a video consultation may be the simplest and best option; for others, an in-person appointment is necessary. The important thing is therefore not to choose sides between “digital” and “in person”, but to choose the form of contact that makes the most clinical sense in the particular situation.
Imagine a person with ADHD who has already been assessed and has started treatment. A scheduled follow-up may concern effectiveness, sleep, appetite and side effects. That conversation can often be conducted perfectly well by video, while blood pressure, pulse and other necessary physical measurements are taken locally. For another person in an acute and unstable condition, with severe agitation or a need for a neurological examination, an in-person assessment will often be the right choice. Video can do a great deal, but it cannot perform a physical examination.
Video can also reduce practical barriers. Someone in a smaller town may avoid several hours of travel to a specialist. A refugee may be able to see a psychiatrist who speaks the same language, even though they are far apart. Conversely, a poor internet connection, lack of privacy at home or discomfort with the screen may make the conversation worse. In psychiatry, a closed room, calm and a sense of confidentiality may be just as important as the connection itself.
This is why hybrid treatment is becoming increasingly relevant. The first appointment may take place in person, while later follow-ups are conducted by video; or a predominantly digital course of treatment may be supplemented by in-person visits when the condition changes. The choice need not be permanent. What worked well last month is not necessarily the best option today.
A good psychiatric conversation does not become bad simply because it takes place by video, and a poor conversation does not become good because it takes place in the same room. Quality still depends on professional competence, communication, preparation and safety. Technology must be adapted to people—not people to technology.