A Conversation with Dr. Maricelina Caro on the Advantages and Challenges of Telemedicine

Experienced Internist Marcelina Caro has spent a good portion of her career in a state of transition. After transitioning to telemedicine in order to treat patients, she is now transitioning into Primary Care Psychiatry after a long career in Internal Medicine. Caro’s deep interest in psychiatry stems from the decade she spent working as an internist in a psychiatric hospital, supporting the work of her psychiatric colleagues.

Caro’s formal medical training began at Sidney Kimmel Medical College of Thomas Jefferson University in Philadelphia, followed by training in Internal Medicine at Indiana University in Indianapolis. Board Certified in Internal Medicine, Caro is now applying for residencies to further her scope of practice. She seeks to diagnose and treat severe mental illnesses, including but not limited to bipolar I disorder, schizophrenia, conversion disorders, treatment-resistant depression, obsessive-compulsive disorders, and personality disorders.

In her efforts to surpass her current limitations, Maricelina Caro is looking forward to learning about how to properly administer psychotherapy, assess emergency cases and involuntary holds, advanced treatment options of electroconvulsive therapy, transcranial magnetic stimulation, and ketamine. Providing relief to the severely mentally ill is truly her passion.

After having embraced telemedicine as a convenient option for her many patients, Caro found that the many benefits of telemedicine also offered her the unique opportunity to care for her aging parents and adolescent daughters. In addition to eliminating 10 hours of commuting each week, Caro enjoys her ability to see patients one-on-one without distractions.

Although telemedicine has been a blessing in Caro’s life, she admits that working in urgent medical care through this medium has its challenges. She looks forward to eliminating these challenges through the practice of Psychiatry, where a physical examination is not necessary to successful treatment.

We had the opportunity to sit down with Maricelina Caro who shared her experience with telemedicine with us. She discussed everything from telemedicine’s advantages in providing healthcare services and the challenges she has encountered and overcame while delivering medical care remotely to the technological tools and platforms she utilizes effectively.

How has telemedicine impacted your ability to provide healthcare services, and what are some of the key advantages you’ve observed?

I appreciate the flexibility of being able to reach people wherever they happen to be—it’s like making a house call. This approach eliminates the inconveniences of taking time off work, commuting, waiting in crowded spaces alongside strangers who may or may not be feeling well, and then making the return trip. Many individuals choose to meet during their lunch breaks inside their cars or in quiet corners during their work breaks, making it incredibly convenient.

For me personally, I find great comfort in conducting business from my home office. Here, I can set the temperature to my liking and have a chair that suits my preferences. The absence of external distractions and discomforts allows me to focus entirely on the task at hand.

What are the main challenges you face when delivering medical care remotely, and how do you overcome them?

Initially, I had concerns that the transition to telemedicine might rob me of that elusive sense of a person’s well-being—the kind of intuition I would often pick up during in-person meetings. I feared that personal connection would be diluted, leaving us with a transactional dynamic. However, I’ve found that video meetings still allow me to gauge how someone is feeling. I insist on video meetings and rarely make exceptions except for emergencies or internet connectivity issues.

While telemedicine posed challenges for physical healthcare, as physical examinations and assessments are essential, I shifted my career focus to mental healthcare. This field lends itself more naturally to conversation and is less reliant on physical examinations. There is an examination component, but it can be comfortably conducted via video—no physical contact is required.

Occasionally, internet connectivity issues arise, or patients may not be familiar with how to initiate their video appointments and activate their cameras.

What background and work history led you into the telemedicine field?

I began my telemedicine journey in urgent medical care. I had reached a point of exhaustion and burnout in my previous work situation, craving a change. A colleague introduced me to telemedicine and discussed its pros and cons. What particularly appealed to me was the prospect of managing my own schedule and eliminating daily distractions. I yearned for the simplicity of caring for one patient at a time without external pressures.

Over the course of my career, I had spent 30 to 60 minutes commuting each day, and the prospect of wasting up to 2 hours of my life daily in a car became wearisome. That added up to 10 hours per week spent on the road!

Moreover, I needed to be present for my aging parents, and my adolescent daughters required more of my time

What technological tools and platforms do you utilize to conduct telemedicine consultations effectively?

I rely on the telemedical company’s designated platforms for documentation. Occasionally, I use Doximity to reach out to patients who have missed appointments or have sent distressing messages through the company’s proprietary portal. Some of the platforms I’ve worked with include Kario, now known as Tebra (https://www.tebra.com/), and Doxyme (https://doxy.me/en/) for patient encounters. Interestingly, even my personal physician utilizes Doxyme.

When it comes to prescriptions, I have utilized Dose Spot (https://www.dosespot.com/). However, the majority of my work involves the use of proprietary medical records programs provided by Brightside (https://www.brightside.com) and Spring Health (https://www.springhealth.com/).

Can you describe a situation where telemedicine was particularly beneficial for a patient and how it improved their access to care?

I have patients residing in remote areas or leading incredibly busy lives, making it impractical for them to travel for in-person appointments. Thankfully, it’s easy for them to connect with me via video chat on their smartphones. The evolution of healthcare mirrors the changes we’ve seen in the banking industry—some tasks can be conveniently completed online, while others necessitate in-person visits. I serve as the remote and more convenient alternative for those seeking healthcare services.