Anorexia, bulimia: get away with the web? : The accompaniment by an e-doctor

If the support of e-patients is easy to find, the accompaniment by an e-medical specialist is less obvious to solicit. As the Anamia report points out, the "positive energies" of the net should be "professionally exploited by health professionals and systems to improve, enrich and extend care" . Where are we today? Is e-health in TCA sufficiently developed? Here is the opinion of Dr. Virginie Saint-Felix, child psychiatrist *.

> Online discussions
Commonly called "chat", online discussions are an opportunity to ask questions to one or more health professionals. At a pre-defined time, they respond - directly - to questions from users, a chat room or Twitter.

Or ? Despite the demands of e-patients, these cats remain rather rare and are confined to general health sites such as Health AZ, ... None are relayed or initiated by the associations of patients with TCA.

The opinion of the pedopsy

On-line discussions have the advantage of quick and diverse interactivity. They allow both sensory immersion, intensive interactivity and the presence of a real body beyond the image. It is also an opportunity for us professionals to psycho-education on the disease, a key component of care.

> Online medical advice
Thanks to the advances of e-health, it is now possible to obtain personalized advice online from a health professional. Their forms are variable: mail, video ( Skype type ) or instant messenger on smartphone, etc.

Or ? France M├ędecin is an example of a platform accessible from home, facilitating the connection between doctors and Internet users. But if the format is close to it, it is not yet true consultations!

The opinion of the pedopsy
Telemedicine can not replace a face-to-face clinical interview, but it can facilitate the process of care. Because patients with anorexia and / or bulimia are often paralyzed by shame and delay seeking direct care. It's a way to preserve anonymity, to say things while remaining hidden behind the screen, without feeling too shameful.

> Therapeutic support programs

Developed and developed by health professionals, these therapeutic support programs delivered via the Internet are starting to emerge. In the manner of coaching programs, they accompany the patient towards a better behavioral management of his disorders. Through exercises, diaries, tips, etc.

Or ? The only one listed to date is the European program Hi (// used by Montpellier CHRU in the management of bulimia. The effectiveness of the program (in addition to clinical management) was evaluated in randomized controlled trials in Sweden, Spain, Switzerland (French version) and Germany.

The opinion of the pedopsy

Exchanges via the web have their place, especially at the beginning of the care process: when the therapeutic alliance is not yet installed, or when the patients are still at a "contemplative" stage of motivation for change. Professionals could thus give realistic information about the disease, make patients feel guilty, help them to go beyond ambivalence and accept to change their situation ... in an attitude of understanding that is free of any judgment.

* She is also the author of a thesis on the use of the Internet in the Behavioral Disorders.

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