I’m angry. The sound cut out again, for the fifth time in the last hour. “Why can’t I get through one telemedicine visit without some technical problem?” I ask myself. I can feel the chest discomfort, my shoulders tense, I start to flush, tell-tale signs of frustration and anger bubbling up. I did not go to medical school to become tech support. After 12 patients, it’s finally time for lunch. I get up from my chair and notice that my low back is sore, as are my shoulders, and my eyes are very dry—all occupational hazards of telemedicine, sitting in one location for much of the workday.
Having lost track of how many surges we have and will continue to encounter with COVID-19, telemedicine is undeniably here to stay, more fully integrated into our health care system than ever. Overall, I believe this is a positive, as it improves access for many of my geriatric patients who have high-risk co-morbid conditions, putting them at risk for having severe COVID-19 infections and complications, already limited in their mobility, or do not drive anymore. With how contagious Omicron is, pivoting to seeing more telemedicine patients also helps protect us, the health care professionals, and support staff.
Let’s be real, there have been patients who have arrived in clinic who you sent for COVID testing, and ended up being positive shortly after the visit, or brought a visitor that turned up to be positive. Exposures almost two years into the pandemic era have become countless, even in outpatient settings. When possible, pivoting to more telemedicine during Omicron helps keep the healthy health care professionals doing what they do best. However, there is a cost: I sometimes struggle to get a sense of how my patient is doing by only looking at their face. I miss hearing lung sounds, having true eye contact, and firm handshakes of connection before and after the clinic visit.
After a day of telemedicine patients, I find myself more physically and emotionally exhausted than had I seen them in person. Part of this is due to the ergonomics of the telemedicine setup: feeling stuck in the same place in mostly the same position, looking at the same screens, and repeating, over and over again the same words of, “Can you hear me? How about now? Can you hear me now?” I’m worried about her “what ifs …” – our expert catastrophizing for our patients has become more prevalent for me, worried I am missing a key physical exam finding that could mean the difference between life and death because some of my patients are not great historians. Telemedicine requires us to rely even more on the accurate recounting of a patient’s subjective experience, as we try to distill it down into some semblance of objectivity, but with less objective data, namely the lack of the physical exam. And when our patients are not capable of being historians, we rely on their loved ones or caretakers to provide a third-person history, but without the physical exam to help us assimilate valuable, sometimes nuanced information about our patients that a clinician is trained to detect.
Telemedicine exhaustion is real, and it is yet another ongoing potential source of burnout that health care professionals face. May I offer some tools that have helped me?
1. Ergonomics. Ensure that your workspace is set up to provide you with maximum physical comfort: screen at eye level, chair height that enables you to place both feet flat on the ground, key-board, mouse, speaker/microphone located where you do not have to strain to reach, keeping your elbow as much as possible at a right angle while you are typing. If you do notice any tension or pain, take a moment and think about what you could do to help bring more physical comfort to you, and do it; it might be as easy as doing a few shoulder and neck rolls. Work standing if you have that option.
2. Breaks. I go outside for a walk during lunch, looking at the sky and the trees around me. This is an intentional mini-mindfulness practice. It helps reset me and refreshes me for the next 12 patients. Can the “start” button on the telemedicine window become a reminder for you to take an intentional deep breath as a moment of reorienting to the present moment before the visit?
3. Intentional social curiosity. Part of the exhaustion is the loss of physical and emotional connection we have with our patients over the contrived atmosphere of telemedicine — can you broaden your curiosity about your patient to include something in their environment that you might not have known about your patient? I’ve met more pets than I can remember now and meaningful artwork hanging in my patient’s homes with fascinating stories behind them, a social connection that otherwise would not have been forged had it not been for this unique opportunity to have a view inside our patient’s homes and be authentically curious about some new facets of their life.
4. Blue light protection. We know that the blue light emitted from monitors and the screens on our phones decreases melatonin secretion, adversely affecting our circadian rhythms and increasing irritability, amongst other detrimental effects to our well-being. Being mindful about not looking at screens 2 to 3 hours before bedtime and protecting eyes can be extremely helpful in reducing dry eye and optimizing sleep hygiene.
As Steve Hickman, PsyD so eloquently suggests, “Let’s be present to absence, without becoming absent to presence.” We are doing the best we can. Despite disagreements in some of my patients’ thoughts or actions about COVID-19, I believe that our patients are doing the best they can. We are in this unprecedented time of what seems like constant adjusting to our new normal together. Let this time be a much-needed reminder that we cannot care for others unless we care for ourselves.
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