Embracing telemedicine – a lesson in compassion


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7 comments

  1. Susan Glover Takahashi

    Thanks for a thoughtful piece on how you have transformed virtual care to both patient centred, helpful clinically and satisfying personally. Assume video would add more nuance to the virtual visit if/when available.

  2. Darren Larsen

    Mala… this is a brilliant piece of self-reflection, and dead-on. I went through this same reflection myself and came to the same conclusion you did. There are some aspects of what we do that require an in-person visit, and I never want to underestimate the therapeutic effect of the the “laying on of hands” that creates a relationship of trust over time (even just a handshake upon entering the same room, or a reassuring hand on shoulder upon leaving, letting a person know that you are there for them is so powerful). But there is a balance between that and meeting other needs like patient choice, convenience, time loss in the day, stress reduction, the benefits of a virtual “house call” and more in a video visit or telephone exchange. We are all learning this in real-time.

    I say this again and again… virtual care is, simply, care. It behooves us to provide the right service for the right problem for the right patient at the right time… which also builds amazing amounts of trust.

    I applaud your writing. More, please!!

    Darren Larsen, MD, CCFP, MPLc
    Chief Medical Officer, OntarioMD
    Lecturer, DFCM and IHPME, University of Toronto.

    • John Van Aerde

      Agreed, Darren. “Virtual care is, simply, care.” Absolutely, it is CARE. I wish, at the beginning of times we would not have called it ‘virtual’ as it is REAL care. Virtual is supposed to refer to the technology, and unfortunately it now stands next to the word care. ‘Online care’ might have been more accurate terminology. Semantics, off course, and the fact remains, it is indeed REAL CARE.
      Johny

  3. Anne Janssen

    This is interesting to read and as a caregiver I very much would like tele care to work. My mother and father both have difficulty hearing- especially over the phone. Do you think that they are exceptions and that in such cases care must always / continue to be in person? Thank you.

  4. Barb

    I understand the benefits of remote “care” in certain disastrous situations. However, there are many concerns I have with this issue. #1 – nothing replaces face-to-face in person communication (with eye contact, empathy, focus). I work in a hospital and I see how “busy” or rather distracted residents and doctors are; texting on their phones non-stop, will look down and lose eye contact, curt; my own doctor often looks over at something on the computer when talking to me, or gets distracted by pagers / phone calls. I don’t trust a doctor to engage for 10-15min online and actually focus on my needs (likely they will be emailing, looking something up, distracted). Also remember that your doctor will still charge the government for $$ for your “care” online, despite this care being of lower quality. Lastly, one of the hallmarks of patient exam is the observation of the patient – do they look healthy, tired, pale, frail? how is their mood? what if your condition requires hands on or eyes on exam (e.g. skin issue?) – Do you think these signs and symptoms would be easy to gather over a brief grainy video?
    #2 – certain professions should not be encouraged to continue with “online” treatments, such as those which require hands-on assessment and therapies (e.g. physical therapy, chiropractic, ND), otherwise you are just becoming an expensive “trainer” providing exercises / advice verbally, and I really feel this will tarnish the reputation of these professions in the long term. I have noticed these professions are still charging standard fees in person fees for these online discussions.

    At the end of the day, nothing replaces in person contact. There is extensive research on how technologies and social media have detrimentally impacted our social norms, communication, and empathy – especially in children and teens. Let us accept this idea as a temporary solution to this health problem or as an adjunct in specific situations (e.g. individuals living remotely) and move back to the

  5. John Van Aerde

    Well written and great reflection. Yes, we can change our mental models (with difficulties), and the first step is awareness which you describe so beautifully. What other mental models do we need to tackle in Medicine?
    Thank you!

    John(y) Van Aerde, MD, PhD
    Exec Medical Director
    Canadian Society of Physician Leaders

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