“How is she? What happened?” – a family member asks me anxiously over the phone. I pause and proceed cautiously. “What is your understanding – “ I am cut off. “Just tell me what happened.” Again, I pause. “I am very sorry sir, and I am sad to say that your wife has unfortunately passed away.” A long silence ensues … he mutters an expletive.
As a physician, delivering bad news such as this to patients and their families is a difficult and heart-wrenching task. Now, during the pandemic, I am tasked with delivering this same information, but from behind a mask, and too often, over the phone. Already, building the patient-doctor relationship is a craft that, like other aspects of medicine, requires practice and fine-tuning. While I have practiced having difficult conversations with patients many times over as a medical student, I failed to prepare for a pandemic that has interfered with many inherent means of emotion, empathy, and communication. In this way, the COVID pandemic, while wreaking havoc on much of society, has also crippled the relationship between doctors and their patients.
The pandemic’s emotional toll on doctors is well documented, with doctors reporting increased levels of anxiety and depression, and even at times, feeling desensitized to the pandemic and disconnected from patients. I too, feel this distance from my patients, both physically and emotionally. For starters, my ability to exhibit simple emotions is compromised by the fact that the greater portion of my face is hidden behind a mask and the glare of a plastic shield and goggles. Layered in PPE, I feel unapproachable, sterile, and barricaded from those I am caring for. Too often, I stand with my arms glued to my sides, watching a crying patient or family member, reluctant to place a reassuring hand on their shoulder, and never daring to offer hug. What is worse? The appearance of being soulless and aloof, or risk transmitting virus that may or may not have splattered on my scrubs in the room of my last patient … or the patient before that.
Beyond blunting gestures of empathy, the pandemic impedes on simply talking to patients. I find myself nearly shouting through my mask to assure that patients can hear me. Still, my words come out muffled and muted as though I am submerged underwater. This is not conducive to patients trying to learn and understand why they are feeling unwell and does little to facilitate conversation, reassurance, and comfort for patients. By the end of my patient encounters, I am breathless behind my mask, with beads of sweat trickling down my back, and my goggles are fogged with condensation. In this environment, casual banter and friendly conversation become seemingly less essential, and sadly unappealing.
Adding to the distance between doctors and their patients, an increasing number of doctor’s appointments are being conducted via telehealth. While such modes of health care delivery can be effective, there are still many aspects of medicine that are seemingly more difficult to handle over the phone: explaining different treatment options, informing family members that a loved one is deteriorating, or discussing end-of-life care. Or even worse, informing the family that their loved one has died. I do this with my head in my hands and holding the phone close to my ear, as if such a gesture will relay just how sorry I am – a pitiful display of empathy, as I sit listening to silence on the other end of the phone.
For someone who pursued medicine in large part for the unique interactions, we as physicians have with other people, the toll of the pandemic on patient-doctor interactions has been particularly trying. Although I am an intern, starting my career during the pandemic, I can still sense there is something missing from my day-to-day work. As a medical student, some of my fondest memories are of conversations I had with patients and the stories they shared with me. I pursued a career in emergency medicine because I wanted to continue to hear these stories. I embraced the challenge of making small connections, meeting a wide variety of patients, and earning their trust, all in a brief encounter. Now, here I am, finally practicing medicine as a resident, yet the humanism that drew me to the field in the first place is lacking.
With a vaccine being rolled out, and a possible end to the pandemic in sight, I cannot help but wonder about the lasting impact the COVID pandemic will have on doctors and our interactions with patients. Among many things, the pandemic has reminded me of the physician-patient relationship’s precious nature. Without it, we as physicians, as well as our patients, are at a loss. Therefore, let the pandemic be an opportunity for all of us to place a heightened focus on ways in which we can be more attentive, more caring, and more human. Let us work to assure that our patients can see that we are still caring for them through the many layers of PPE.
John DeGuardi is an emergency medicine resident.
Image credit: Shutterstock.com