Is Telemedicine Putting the Patient Connection at Risk?

The novel coronavirus has sparked an unprecedentedly fast and widespread shift to telemedicine. It is remarkable that so many patients can still get care despite the social distancing required by the COVID-19 pandemic. But some view it as a pale comparison to in-person visits.

There are some obvious limitations to telemedicine like taking vital signs, giving injections, or testing for spasticity. That, however, is not all there is to the doctor-patient relationship. The Modern Hippocratic Oath reminds us that doctoring is more than just physical interventions:

“I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon’s knife or the chemist’s drug.”

Telemedicine quite literally introduces a sizable distance between provider and patient, and it begs the question: Is it possible via telemedicine to maintain the emotional connection so important to patient care?

We talked to three neurology providers who think it is possible: Dr. Heidi Schwarz, Dr. Laurence Kinsella, and Calli Cook, a nurse practitioner.  Here is what each had to say when we asked them this question and how they bridge the technological distance.

Schwarz: “It’s true, you can’t hand them a tissue when they get teary eyed, and you can’t hold their hand, but you can still empathize with them. The body language is there, the eye contact is there.

“There is also actually a different level of intimacy that you can have with these patients because you’re actually seeing them in their home territory. I can comment, ‘wow, that’s a really interesting picture you have on the wall’ or ‘That chair looks really comfortable.’

“Sometimes people will want to show me around their house a little bit. I get a much better sense of the calmness or the chaos of their home environment.”

Kinsella: “I think it actually has gotten easier because suddenly we are inside their homes and we can see the photos of their parents and children. We can see the books on their bookshelves. We can see the artwork they have.

“You have to double down on your communication skills and the ability to establish rapport has never been more important. But we’ve already got a head start because the patient is not in some sterile office.

“Going to see a doctor is not something people like to do. So, if they can do it in their home, it is just remarkable how much more relaxed they are. I think for the especially anxious patient, it is a better way to do an evaluation. They are in their own comfort zone where you are likely to get a much better history.”

 Cook: “I’m very mindful of where my eyes are when I’m doing a telemedicine visit.

“You really need to look at that camera. You want to watch them [on the screen] when you are examining them, but when you are speaking with your patient, you want them to see you looking at them and not looking down. When you take your eyes off the screen, it might indicate that you may be disengaged.

“If you do need to stop and take a note or e-prescribe, you want to make sure that you let the patient know that’s what you’re doing. When I’m in the exam room they can see what I am looking at, but when we’re connecting remotely, they don’t know if I’m rubbing my dog’s belly or writing in their chart.

Special thanks to:

• Heidi Schwarz, MD, professor of clinical neurology, University of Rochester Medical center, Rochester, NY, specialist in headache medicine
• Laurence Kinsella, MD, neurologist at SSM Health Neuroscience Institute, St. Louis, MO, board certified in internal medicine, neurology, neuromuscular medicine, electromyography and autonomic disorders
• Calli Cook NP, DNP, APRN, FNP-C, nurse practitioner at Emory Physician Group Practice, Atlanta, GA

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