LAUSR

In his recent JAMA Psychiatry article “Managing Virtual Hybrid Psychiatrist-Patient Relationships in a Digital World,” Shore (1) makes a convincing case for psychiatrists to be familiar with developing technologies as they affect both the doctor-patient relationship and clinical outcomes. His scope usefully identifies administrative, operational, and clinical domains relevant to the use of various technologies, including email, text message, videoconferencing, web-based patient portals, and social networks. Conspicuously absent from Shore’s argument is any consideration of research governance vital to the ethical development and application of these new technologies. He also neglects to mention another clinically promising technology; virtual reality (VR) has been studied in several psychiatric conditions (2) and is distinct in that it places patients completely within a digital, multi-modality, three-dimensional space, and enables direct interaction with that virtual environment. Clinicians need to know that VR is primarily accessed through head-mounted displays and that patient movements within the virtual space can measured by external or internal device sensors; handheld controllers allow direct manipulation of the virtual environment which can also be measured and analyzed to provide data relevant to treatment optimization (2).