Before the Covid-19 crisis, I — like most physicians — thought that in person, face-to-face encounters afforded me the greatest level of connection and intimacy with my patients. Yet many of us have been pleasantly surprised to discover the perks of telehealth during the unprecedented coronavirus crisis.

Centuries of doctor-patient relations have centered on in-person communication and physical examination. We have been conditioned to view that as the norm, causing us to see telehealth as disembodied and impersonal, making us reluctant to embrace it.

Then came the Covid-19 ambush. With mandated social distancing policies in place to counter the rapid spread of a highly infective virus, health care providers have been forced into an overnight arranged marriage with telemedicine. For some of us, there is the potential for true love.

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Telehealth has many advantages, including keeping patients safe from possible exposure to the coronavirus that causes Covid-19, improving access to care, cutting health care costs, and contributing toward a greener earth by cutting down on car trips to see doctors in their offices. It also offers its own type of personal and lighthearted or even heart-warming connections.

Over the past few weeks, I have had conversations with several colleagues about this new wrinkle in our professional lives. Here are some of the things we enjoy about telemedicine in the time of Covid-19:

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  • Seeing our patients in their pajamas.
  • We can work in pajamas, too.
  • Finally “meeting” the dogs and cats they talk so much about.
  • Gently reminding them about social distancing as their grandkids play on their laps.
  • Feeling amazed after a successful FaceTime visit with an 89-year-old.
  • Getting magnified views of chin hair, moles, nostrils, and other facial features of patients who aren’t fully familiar with the cameras on their phones or computers.
  • Conversing about their home décor and choice of wall color.
  • Realizing that it’s now acceptable to enjoy a cup of coffee with our patients.
  • Actually seeing ourselves as we chat, and fixing our hair or smiles in response to the image in the video window.
  • iPads are now a legitimate business expense.
  • Having far fewer test results to review since patients aren’t coming to the lab for tests.

If laughter is indeed the best medicine, and if this sampling of anecdotes is any indication, my colleagues doing telehealth are quite healthy:

“I just spent an entire televisit looking at a patient’s ear canal.” — an oncologist in New Jersey.

“I find it rather difficult to do pelvic exams with virtual visits.” — a gynecologist in Atlanta.

“I thought virtual visits were going well until my patient decided to show me his hemorrhoids.” — a gastroenterologist in New Jersey.

To be fair, this optimistic view of telemedicine must be balanced against its downsides, including the inability to do physical examinations, which can affect patient care; the inability to obtain essential blood work; the inability to console patients when giving bad news; and more. To get through the time of Covid-19 with as little PTSD as possible, physicians need to keep their rose-colored glasses on, at least now and then.

During virtual visits with patients, when I hear their children crying or see their dogs on their laps, a certain friendship develops that otherwise wouldn’t have incubated in an office setting. As a colleague, Dr. Bonnie Guerin, told me, “It’s just a different vibe.”

For some of us, our arranged marriages to telemedicine might morph into love. If Gabriel García Márquez were still alive, he might have called these silver linings “Love in the time of corona.”

Rujuta Saksena, M.D., is a hematology and oncology specialist in Summit, New Jersey.

  • I was screened via cyber-visit with my Doc for an odd skin growth, then treated at the fully Covid-kosher clinic 28 km away. One visit, not two. Telehealth supports health care delivery that is far less cumbersome for many patients and doctors alike. The personal touch is indeed silver lining that works both ways. This prior under-used mode of consulting should be sustained and expanded on – through and also after this pandemic.

    • Thank you for sharing your story, sounds like it was a positive telemedicine experience. Completely agree with you – this has been an underutilized modality until now and should be recognized as an important tool to improve access to care even after the pandemic has resolved.

  • As a healthcare provider who have been using telemedicine for years, I love the sentiment of this post. I think the “arranged marriage” to telemed is much more than a silver lining, it is home run!

    The way we communicate in healthcare and the “shape” of the office encounter has long been determined by the CPT and ICD codes. This has placed clinicians in a technological disadvantage. Compare the advances in other industries such as banking, travel, and even education over the last 30 years to the healthcare market. Do we have better diagnostic tools, procedures, therapies? Yes, we do. But do we communicate better before, during and after we use these “features”? We don’t. The analogy would be an airline company touting its newest airplane being safe, fast, comfortable, and environmentally friendly, but in order to make a reservation, you’d have to go in person to their designated agents. And after seeing the agent, to ask any new questions, you’d have to make a new visit. It sounds ridiculous in travel, but still a normal operating procedure in healthcare.

    COVID-19 forcing the hands of insurance companies and clinicians to look past the old ways and catch up to technology, is making healthcare better.

    • I’m glad you enjoyed the article! You are ahead of the times if you have been using telemedicine pre-COVID-19 days, but for those of us who have accepted it due to the current crisis, it is easy to see the upsides. A lot of our decisions in medicine are driven by the framework of our work environment, insurance company mandates, and reimbursement protocols but it is really up to the public health leaders to look at this crisis as a way to reevaluate healthcare and it’s costs, and promote telemedicine for patients and providers alike – of course to be utilized in the appropriate settings.

  • Why can’t you order blood tests with televisits? Sure you can. With the right EHR setup, it’s very easy.

    • You’re completely correct- providers absolutely do order necessary bloodwork during virtual visits. With the current risks of COVID-19 exposure, many routine, non-essential labs are being delayed. As a result, appointments to discuss lab results are only going to be temporarily reduced – hopefully we’ll be back to normal soon! 🙂

  • Please look at this from the patient’s point-of-view. During my recent illness, I was being called in for appointments to speak to a nutritionist, nurse practitioner, etc. When an in-person visit is not required, I really resent being asked to do this. Even a short consultation consumes half a day, from the time I begin getting dressed, travelling to the hospital, time in the waiting room, travel home, and de-stressing. It’s as though the hospital considers my time and convenience utterly worthless. The last time this happened, I asked whether the visit with the nurse practitioner could be done over the phone. She said no, these tests results are really important, you have to come in for this. About three days later as the covid epidemic ramped up a little more, the hospital decided to convert everything possible to phone consultation, so they let me convert that contact to over the phone. A good effect of the pandemic might be breaking medicine out of its long-time habits, like the feeling you have to see a patient in the office in order to be doing your job.

    • Thank you for your added perspective. I agree that habits need to be reassessed periodically and certainly before they become completely ingrained within our culture. Your time is valuable as is your satisfaction with the Health care system, and I am hopeful that this pandemic will result in a more permanent shift in the way medicine is practiced. I’m expecting that healthcare providers will be more receptive to telemedicine especially for visits that do not entail physical examinations or bloodwork. Wish you the best and stay safe.

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