The Voice of Telemedicine Series: Dr. John Gavazzi

About Dr. John Gavazzi I am an independently practicing psychologist in Central Pennsylvania. While my job duties include consulting with state and federal agencies, I work with 20 to 25 individuals or couples per week. Of those, I likely see one to four patients per week via Doxy.me.

What's your background? Specialty? How long have you been practicing? Where is your primary location? My educational background includes a Bachelor’s Degree in Psychology from Pennsylvania State University, a Master’s Degree in Psychology from Duquesne University, and a Doctoral Degree from Indiana University of Pennsylvania. The Pennsylvania State Board of Psychology issued my license to practice psychology in August, 1990. I earned board certification in Clinical Psychology through the American Board of Professional Psychology in 2001. My approach to psychotherapy is eclectic, using cognitive-behavioral, existential and psychodynamic concepts to help patients overcome their emotional suffering.

Along with my clinical and consulting responsibilities, I also enjoy ethics education. I frequently present on topics such as ethical decision-making, risk management strategies, legal obligations, and clinical concerns. Because of the advent of telepsychology, I am starting to present on this topic as well.

How long have you been practicing telemedicine? Practicing telepsychology was not a planned event. In other words, I did not strategically contemplate how I could expand my practice or alter my practice patterns. A little over a year ago, one of my patients was traveling about an hour to meet with me on a weekly basis. He asked if there was a way that we could have phone sessions or meet via Skype. Having done a podcast with Marlene Maheu from the Telemental Health Institute, I knew that Skype did not offer a HIPAA-compliant platform. I did some research to find that Doxy.me offered a no-cost platform to provide telepsychology services. After experimenting with the technology with friends and family members, I felt sufficiently comfortable to start working with this patient via Doxy.me. I also reviewed the law to practice psychology in Pennsylvania. There is nothing in the psychology licensing law to prevent me from treating patients via a HIPAA-compliant platform. I also needed to become qualified through his insurance carrier and know how to code correctly for telepsychology services. After all of this legwork, we agreed to start meeting via Doxy.me, and still meet face-to-face twice per month.

What motivated you to start practicing telemedicine? Telepsychology has become a great platform to provide high quality psychological care for my patients. First, some patients request telepsychology services for convenience. For example, some patients want to spend less time in the car for appointments. Second, I am able to work with agoraphobic patients who cannot leave their homes. Third, when a patient has car problems or a babysitter cannot make it, she or he can still meet with me over the internet. Finally, during crises or emergency situations in which the patient cannot come to the office, I can still provide services with Doxy.me.

Telepsychology is a convenient means of working with patients, but not all psychotherapy patients are good candidates for telepsychology. Patients who are clinically complex are likely not good candidates for telepsychology. Additionally, patients who do not live within an hour of my office may be a higher risk for me. Due to interjurisdictional restrictions, I can only practice within the Commonwealth of Pennsylvania.

What challenges have you experienced practicing telemedicine? How did you overcome them? The biggest challenge with telepsychology is bandwidth, bandwidth, bandwidth. While my preference is seeing patients from my laptop or desktop computers, sometimes I need to use the mobile app on my phone. Some patients either have low internet speed or some technological obstacle (e.g., outdated modem) that prevents a clear connection. Educating patients about the technological aspects of telepsychology is another challenge when working online.

What advice would you give to other healthcare providers interested in starting telemedicine? My best suggestion for those starting out in telepsychology is to offer current patients to use Doxy.me, if they are sufficiently savvy from a technological standpoint and their insurance covers the use of telepsychology. I started with one patient and currently carry several patients on my caseload who either prefer or almost exclusively use Doxy.me. I have used Doxy.me when patients have felt ill, dealt with other physical problems preventing them from getting to my office, or had transportation problems. While I don’t see any patients with a disability that would make travel to my office burdensome, I can envision how this would be helpful as well.

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Dylan Turner

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