Remember the art of medicine during virtual visits

The COVID-19 crisis has forced upon us the rapid adoption of telemedicine with all its advantages and flaws. It has certainly allowed physicians to evaluate patients safely and to assess them while continuing to allow them to physically distance.  It many cases, it has allowed for the recognition of an exacerbation of a chronic illness that the patient had otherwise neglected, fearful that leaving their home and going of all places to a physician’s office or ER would expose them to the novel coronavirus.

However, the sudden implementation of telemedicine during the COVID-19 crisis has occurred without the opportunity to fully comprehend all the effects that telemedicine may bring to the practice of medicine.

As a practicing endocrinologist, like most primarily outpatient-based physicians, I experienced a significant decline in patient visits in March and in early April 2020, as the shelter in place orders were issued here in California.  In response, our health care organization rapidly adopted telemedicine, and within two weeks, we were seeing patients via the Zoom platform just like in so many other physician offices across the country.

Patients were pleased to be able to take advantage of telemedicine technology.  They were able to remain in their workplace or at home, safe and unafraid, and immediately appreciated the convenience that telemedicine provides.  I could immediately sense that the many patients preferred it over the conventional in-office visit.  Certainly, for the asymptomatic patient in a cognitive specialty practice, and with the ability to upload blood glucose data from meters and continuous glucose sensors, an endocrinology telemedicine visit can more than suffice in many cases.  However, more than just the inability to examine a patient is lost during a telemedicine visit.  I fear that telemedicine minimizes the important and vital humanistic role that physical presence plays in the physician-patient interaction.

This week, I had a post-hospital telemedicine follow up with a newly diagnosed type 1 diabetic.  She had just been discharged from the hospital, after having experienced the physical toll of diabetic ketoacidosis and the emotional toll of learning that she has a lifelong dependence on insulin therapy. I had seen her daily in the hospital, gradually helping her recover from her severe acidosis, but as in most cases of hospitalized diabetics, there was little time nor resources available for diabetic education in the hospital.  As I sat staring out at her on my computer screen, I realized that telemedicine does not allow us to truly practice the art of medicine and demonstrate to patients the presence and human connection required of a physician.

Now, under shelter in place restrictions, even my peaceful Zoom background with the calming shore break, was not enough to properly temper her anxieties or allay the fears of her concerned parents.  The art of medicine requires a physical connection.  For a newly diagnosed patient, learning the complexities of the rapidly evolving technology now available for the management of type I diabetes can be daunting and isolating. Instruction in how to insert a continuous glucose sensor or administer insulin with an insulin pen requires demonstration and theatrics and is our opportunity to show the patient that we are confident, experienced partners in the care of their diabetes. Simply asking a patient to watch a YouTube video does not suffice.

Hippocrates wrote, “Wherever the art of Medicine is loved, there is also a love of Humanity.”  Now that telemedicine has become a standard and necessary offering in most medical practices, it is here to stay.  And with it, both providers and patients may experience an unavoidable and inexorable loss of their humanity unless we remain vigilant and make active and consistent efforts to cultivate a true, meaningful physician-patient relationship. Otherwise, we physicians may one day be joyless technicians sitting in front of a computer screen.

Joseph Barrera is an endocrinologist. 

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