None of the professionals who examined the 15-year-old boy could find a medical reason for his abdominal pain, though the cause seemed obvious to them all: months earlier he witnessed his older brother’s murder by a drive-by assassin outside their Philadelphia home. He had never discussed it, not even with his mother. It was seven in the evening and the onsite psychiatrist was not due to arrive until the following morning; however it was obvious that the boy needed immediate assistance.

The social worker in the ER called Dr. James Varrell, the president and medical director of InSight Telepsychiatry Services, to attempt a telepsychiatric consultation. Within one hour, the consultation was arranged and the patient appeared on the screen with his head covered by a blanket.

"It was clear he did not want to participate,” Varrell recalled.

The young man eventually revealed his face and looked at the monitor. "Where are you right now?” he asked Varrell as he began to play with the camera that was pointed at him. "And what is all this stuff?”

While explaining the technology, Varrell carefully steered the conversation toward the young man’s pain. "Has anything stressful happened to you that might be causing your pain?” Varrell asked.

The patient, for the first time, relayed his eyewitness account of the slaying. He told how he watched as his brother was shot, then died before the ambulance arrived. Yet, in the days that followed, he was somehow indifferent about his brother’s death. However, the tragedy soon hit him hard, and he was deeply troubled that initially he was not affected by the loss. Tears flowed as the teen described the feelings of guilt that left him unable to function.

The use of telepsychiatry opened him up to talking where the traditional form of communication had been ineffective. The patient was admitted to a mental health facility, where he opened up further. The abdominal pain was gone when he was discharged after a two-week stay.

"As much I would like to say it was due to my skills that he opened up, the fact is that it was his interest in the technology that allowed for the breakthrough,” Varrell said. "Patients are curious about the process and talk more than they expect to. The conversation continues and eventually touches on the problem that placed them in front of the camera. This case provides a tremendous example of the benefits of this technology.”