I Would Like to See My Doctor: Social Distancing and Telemedicine
My first COVID-19-era "telehealth" video call had me looking up my doctor's nose. Who could blame him for turning his camera off?
I poured Cheetos onto a salad yesterday because I did not have croutons. Before the coronavirus pandemic, I ate one bag of vending-machine-sized Cheetos per year. I now eat Cheetos daily, because I have given myself permission to eat whatever I crave in the event of an Apocalypse. Once I overcame the cognitive dissonance of Cheetos on spinach, I dug in and realized two things:
1. Croutons are essentially Cheetos without the neon coloring; and,
2. Social distancing is changing my life in unexpected ways.
It is not just my novel embrace of Cheetos as a creative condiment/quotidian snack. Or my newfound interest in baking banana bread. Or the fact I have been furloughed from my job. My healthcare regimen, too, has changed.
Shortly before Illinois issued its stay at home order, I awoke the day of a routine appointment with my psychiatrist, suffering from a heaviness in my chest that might have been a cold coming on, or the onset of COVID-19 or, maybe just a sinking feeling that the world was ending. Now didn't seem like the time to risk the intersection of hypochondria and infection. So I called the office and asked to reschedule.
They made me an offer I could not refuse: See the doctor via "telehealth" video call at the appointed time that day, or pay for the missed session (which is their last minute cancellation policy, which I had never invoked) and take my "I was sick that day" excuse to the billing office, which might or might not issue me an "extenuating circumstances" refund.
I am not a video call person. I had done it for work and with family. I knew how. But no one needs to see my pajamas, the awkward hang of my curtains, or my unfolded blanket collection. Not even my psychiatrist. But there was no way I was going to pay for a missed session and then chase a refund; plus his office promised (inaccurately) that the session would be covered by my insurance, so I agreed to see my doctor virtually.
I logged on early to familiarize myself with the website. It was not much different from similar sites. It eased my mind, though, to test my camera and microphone, and to feel oriented. Everything worked on my end. My doctor logged on. Then off. Then back on. "It's my first time," he apologized. I was not sure whether he meant it was his first time using that website or if it was his first video call. I got the sense it was both.
The session got off to a slow start because I had to instruct him on where to click to control his camera. When we could finally see each other, it was god-awful. I could see he was in his office. I could also see his nostrils, which dominated the frame while he sought his bearings. I tried to hold my laptop as far from my face as possible, to minimize my own nostril exposure, but I had not been able to get my AirPods to sync, and I could only go so far without my ear-buds popping out. Also, I needed to access the keyboard.
I sat on my family room couch, annoyed with myself for deciding to do this call in a raggedy old sleep shirt. As a rule, I dress up in public. I am the woman in the bright-red/pink/blue dress on a regular day. I wear lipstick and pearls Monday through Friday. Only where was I? At home? Or in public? Or neither? Or both? I was in a strange, invented space and badly dressed. I imagined that my barefaced, pajama-clad self looked to him like a homely impostor.
Worse yet, I lacked the privacy to speak with full candor. My teenage son was home. He is always home now. Most of the time he would be wearing headphones, playing video games in another room; in his own strange, invented space. But our house has an open floor plan, making a conversation in any common area, such as the family room, a public conversation.
If I whispered, the doctor would not hear me. It was too cold to take the tele-conversation outside. I could have locked myself in my bedroom, but there is nothing my child is so determined to learn as what I seek to say privately. If I had gone to my room and closed the door he would have stood just outside with an ear to the keyhole—or pounded on the door for as long as it would take for me to open it and discipline him. I am neither joking nor exaggerating.
A routine appointment with Dr. N_____ would only last 15 minutes. I did not have time to parent and talk with the doctor. I answered Dr. N_____'s general questions aloud, but when they moved into more sensitive territory, I requested we continue the verbal portion of our session via typed messaging. He did not know how to use the messaging function, so I taught him how.
I am a much faster typist than Dr. N_____.
I had never seen a doctor so vulnerable. There he was, trying to attend to my mental health via a platform he had never used before, and which placed us in different buildings—yet uncomfortably close, visually speaking. One never gets closer than four feet during an in-person consult. But via video call, the camera perspectives had us sitting within arm's reach of each other's faces.
Furthermore, my doctor had never seemed like the kind of guy who adored his own reflection—and, with the cameras on, we were also staring into digital mirrors. The furrow of his brow and the way he kept fidgeting with the camera gave me the impression we were living one of his nightmares.
Who could blame him for turning his camera off?
Only now I could not register his facial expressions in response to mine, or to what I had typed.
This was healthcare?
After the stay-at-home order went into effect, C.G., my behavioral health counselor, offered to see me via video call in lieu of our regularly scheduled session. I thought back to my experience with Dr. N_____, and declined. I could wait. At that moment, my blessings far outweighed my problems—and an hour of insufficiently confidential, visually awkward chat was not going to improve my outlook and decision-making.
Now, I worry that the effects of the pandemic (or some bean-counter's bottom line) could make telehealth video calls the new norm.
I have read that telemedicine, besides bridging gaps in care during the coronavirus pandemic, is poised to help many people in underserved communities (Mahar, et al., 2019)—and that the approach is well-suited to mental healthcare maintenance visits because such visits do not require "hands on" medicine (Snell, 2019.)
This may be true. Telemedicine may be better than nothing. However, I prefer to be the vulnerable one when I see the doctor, particularly in a mental health setting.
For telemedicine to work, we need more than technology. Providers will need specialized training and better tools. There also needs to be an understanding by the participating parties of the limits of this medium.
Limits to privacy: What if the doctor had been at his home? How could I be sure our session would not be overheard—through an open window? By a curious teenager? Or by a nosy spouse? Limits to body language: How would I know if the doctor was tapping his foot? Or squeezing a stress ball? Nonverbal, non-facial cues are as important to a conversation as auditory cues, verbal exchanges, and facial expressions. So many nuances of communication are lost when all one can see is a person's face, if that.
If there is anything I hope we have learned from the COVID-19 crisis thus far, it is that healthcare workers are human—they get sick, worry about how their work impacts their families, are not trained for everything they are called upon to do, feel embarrassed when a patient looks up their nose—which makes them, yes, vulnerable—but also unique, complex professionals whose physical presence is not, and should not, be easily replaced. We would do well to take that into consideration in all healthcare settings.
I hope social distancing does not cause a massive, permanent, ill-conceived telemedicine revolution—because I would like to see my doctors again, in person, soon.
Jennifer Companik with white cheddar Cheeto.