In this series, AMS Healthcare addresses the challenges facing healthcare today – particularly in light of the COVID-19 pandemic. The AMS Community promotes compassionate care, development of the leadership needed to realize the promise of technology and the understanding of how our medical history influences the future of our healthcare. A new piece will be posted every Friday on Healthy Debate.
As a specialist physician in practice for 15 years, I value the ability to maintain strong relationships with my patients. I strive to deliver compassionate care no matter the circumstances. That is why I was frustrated and doubtful about providing care when the COVID-19 pandemic and the restrictions that came with it forced a switch to the most convenient form of virtual care, the telephone visit.
In addition to the anxiety related to the pandemic, I quickly noticed an internal dissatisfaction and uneasiness after a day of telephone visits. This mode of delivery seemed less than ideal to me and appeared to interfere with my ability to provide quality care. The explanation that I came up with was that I missed the face-to-face interaction with patients and the inability to have a patient in front of me during the assessment was, frankly, throwing me off.
I complained that I could not see my patients’ facial expressions or body language. I could not see how they moved their hands or how they got up from a chair. As an observant clinician, I needed this nuanced information to make decisions. I had worked for years to develop a style that used aspects of this face-to-face interaction as tools to build relationships with my patients, gather extra information for clinical judgment and let patients know that I cared about them.
The techniques that I had developed to demonstrate compassion – sitting across from patients at eye level, concentrating on body language or facial expression, and taking in their dress, movements or the way they kept their hands – were no longer available to me. Every patient encounter that I had by telephone felt incomplete, like something was missing. What once was rewarding and satisfying now had become disappointing.
And then I came to realize something. The in-person meeting had become of tremendous value to me, the physician, because I had become used to the convenience it afforded me. The difficulty I was having was internal. The problem was me.
I had come to value physician-centred care that involves having patients travel distances, wait long hours in one waiting room and then in another room for an encounter that may last only a few minutes, perhaps only to hear that they are doing fine.
If a physical examination is not needed, then this is a huge burden to the patient. Taking time off work, finding transportation and parking, dealing with the stress of being in another city, finding childcare, the requirements to fulfill the needs of physician-centred care can be significant. All so a patient can make the 15-minute appointment in the specialist’s clinic.
I now understand that telemedicine is one of the most patient-centred ways to provide care and one of the most compassionate things that medicine can offer. I became aware of this, I believe, when call after call, I would hear the palpable ease with which my patients spoke to me from their own environments. And the security that when the call ended, there would be no long trip home. Sometimes I would hear classical music playing in the background or pet dogs barking for attention. These were signs of contentment to me.
Once it became clear that the discomfort was a physician-centred problem, I became mindful of ways to show compassion over the phone and ways to stay present in my patients’ stories even without sitting directly across from them in an examining room. I became aware of the benefits of listening closely and intently and the value of concentrating on patients’ tones of voice as much as their words. I discovered how easy it is to pause and wait for a sentence to finish naturally without interrupting. I would catch myself when I was nodding and stopped this habitual gesture as it is not visible and therefore offers no reassurance to the patient. I reminded myself to speak out loud, which I hope resulted in some reassurance.
Instead of worrying about misunderstandings or that telemedicine was not working for me, I began making sure that my own spoken language is clear and unambiguous.
Part of the reluctance to embrace telemedicine is that it has been presumptively considered a lesser option for delivering care. But is it seen as a lesser option because it is in fact inferior or because it does not align with preferences of the physician?
Having now offered care this way for several months, it’s clear to me that telemedicine is not inferior but a method of making patient-centred care accessible with minimal disruption to comfort and well-being.
While adjusting to the pandemic restrictions, I found ways to be more patient-centred. Where I had thought I would not be able to provide compassion to my patients during the pandemic, the opposite has come true. I just needed to see it and embrace it.