I’m practicing medicine virtually because of coronavirus — and it’s just as strange for me as it is for my patients | Expert Opinion

Over the last few weeks, I have cared for my patients without holding their hands or laying a stethoscope on their chests. I could not pull my chair up close to show my interest and concern, nor could I offer a tissue for anyone’s tears. With telephonic visits, so many of the gestures my patients and I are accustomed to as part of a caring ritual have vanished, as part of social distancing efforts to prevent the spread of COVID-19.

Calling patients on the phone has always been part of my practice routine during nights and weekends on-call, or intermittently during the workday. These calls are mostly for urgent concerns or brief clarifications of instructions. There is rapport-building involved, but it is usually short term and focused. This is the first time in my career, though, when I have had to conduct a follow-up visit this way with a complex, chronically ill patient who I have known for many years. It has been an adjustment for my patients and for me.

Last week, for instance, I spoke with Mary (not her real name), an elderly woman who lives alone and suffers from severe arthritis, diabetes, and high blood pressure. She is also very hard of hearing, which actually proved easier for us, as she could hold the amplified telephone receiver right up to her good ear. She does not have access to a device for video connection. As I listened to her update me on her symptoms and activities, I had none of my usual ways of showing interest and concern with eye contact, head nods, and facial expressions, nor could I see any of hers. It also occurred to me that, with only her voice in the office with me, I was more prone to distraction from various objects in the room. And I had an unchecked fixation on the electronic health record. I recalled the frustrating feeling of hearing the unfocused phone voice of someone who was multitasking during our conversation, something I did not want Mary subjected to. Finally, at one point I sat back in my chair and just closed my eyes. To my great relief, I found myself able to listen more attentively, and our conversation flowed more smoothly, almost like a duet.

The missing physical portion of the encounter felt like a void. A retired nurse, Mary was able to check and report her own vital signs. What I missed most was her typical refrain after my exam:

“So how do I sound, doctor?”

And I would take one of her hands between mine and say, “You sound great Mary, the heartbeat is in rhythm and your lungs are nice and clear.”

Then we would smile at each other and I could see the relief in her eyes.

This time I had to rely on words alone to reassure her and nurture our connection. I had to choose them with greater forethought. It seemed important to directly address what was missing from our steady routine and acknowledge how meaningful her visits are.

“Mary, I wish you were here so I could check your heart and lungs like I usually do, but it sounds like you’re doing very well. I can hear in your voice that your breathing is OK.”

“Oh, that’s good,” she replied. “I suppose that will have to do for now.”

We discussed her recent test results, and the precautions she should be taking during the COVID-19 outbreak. She had friends bringing her food and supplies.

“It seems a bit strange not to see you, but I appreciate your call,” she said.

“It’s strange for me, too, Mary,” I replied. “Let’s get you in right away as soon as the virus precautions are lifted. In the meanwhile, we’ll make the best of this. I’m here for you if you need me.”

I hope this is over soon. I need her, too.

Jeffrey Millstein is a primary care physician and medical director for patient experience-regional practices at Penn Medicine.