Telemedicine is no replacement for meeting with patients face-to-face

The coronavirus pandemic may not change the face of medicine as much as some are expecting.

By CHAYA RABNETT
A worried mother and her child talking to a doctor. (Illustrative) (photo credit: INGIMAGE)
A worried mother and her child talking to a doctor. (Illustrative)
(photo credit: INGIMAGE)
There is a lot of discussion in the medical literature around the world about the changing face of medicine in the wake of the current COVID-19 pandemic. As part of the attempt to “flatten the curve,” access to medical offices, health facilities and testing has been markedly restricted. In some cases offices have closed completely, and all care is being done virtually by phone, email or tele-medicine.
This has been a necessity in this pandemic to protect the health of the populace – particularly those at high risk for complications of the virus – and to minimize the incidence of infection in healthy care workers so they may continue to work and provide care. As a result it is widely felt that post-pandemic medicine will permanently change, with a substantially higher percentage of medical care continuing to be virtual in nature.
While some care can reasonably and safely be provided virtually (e.g prescription renewals, referrals for routine tests), there are many downsides to virtual medicine in comparison to face-to-face personal care. There is no replacement for the personal connection a face-to-face encounter provides. It provides emotional support and allows the nuances of emotional expression of the entire body to be interpreted.
It can be very comforting for a patient to receive a hug or have a reassuring hand placed on them (after current restrictions can be lifted!) in the event of a family death or when receiving bad news. Watching a patient enter your office, negotiate physically to your room and alight onto an examining bed can provide a wealth of information about independence, mobility, gait, balance, risk of falling, etc.
A patient who complains of shortness of breath can be evaluated while resting, and re-examined after a flight or two of stairs, in order to glean a better picture. Nuances of interpersonal family dynamics can be intuited by contact with more than one family member in the room. Is the relationship loving and supportive, or is there concern for emotional or physical abuse? Does a parent show patience with their child, or is he or she withdrawn, critical or short-tempered?
One can provide more information and a detailed explanation of a medical condition to a patient. Showing an image of a heart can help explain a valvular problem. A brief video can describe a surgical procedure, while the doctor is able to answer the patient’s questions in real-time.
Office care allows you to treat a mild to moderate emergency in the office, have the patient remain in a safe environment for observation, and re-evaluate the success of your interventions. That can avoid a visit to an urgent care facility, with its additional waiting time, stress and cost to the healthcare system.
However, a child’s development cannot be evaluated on-line, and you cannot build their trust remotely!
While we may be able to accurately assess vital signs by remote technology accurately (pulse, blood pressure, EKG, oxygen levels) we will miss things. There will be misdiagnoses and missed diagnoses.
For example, a patient with upper left chest pain whose EKG is normal and reassuring, might fail to undress to show you the painful shingles rash on her left chest. Or a remote patient with a cough might get the cough treated, but face-to-face that premalignant skin growth on his chest would have been noticed while listening to his lungs.
For elderly patients in particular who did not grow up in this tech-savvy world, it can be very difficult to navigate an online system. Many do not own smartphones, and even making a prescription request or an appointment can be daunting, particularly if there is a language issue as well.
These are just a sprinkling of myriads of examples where face-to-face medicine remains, in my opinion, an irreplaceable pillar of professional and compassionate care. Our patients become more than patients over the years; they become friends and “family,” and we all know what a strain it has been for families to be separated physically during this pandemic.
Let us hope the true “face” of medicine does not change too much!
The writer has been practicing family medicine for 34 years, the last 25 years of which have been at the Wolfson Family Medical Center in Jerusalem.


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