Age of TeleMedicine

With the Coronavirus Crisis, we are enduring the modern Plaque of our times. Here in the United States, 30 of the 50 States have declared strict social distancing as of this date of writing. This order stopped all work of outpatient surgical facilities and also stopped the regular patient visits to the doctors’ offices making the the nation increasingly dependent on tele-medicine, or remote medicine by using video or other chat technologies. Studies on US patients show that even in normal times a significant percentage of patients are unhappy with the encounter experiences. With the introduction of computer technologies and EHR, some feel increasing impersonal and mechanical atmosphere of the sacred doctor-patient relationship, the basis of which is so personal in nature. This feeling now will accentuate to a higher degree given the providers and the patients are not even in the vicinity of each other. In absence of direct eye contact and touch of physicians or providers, I am afraid the dissatisfaction will sky-rocket.

At the same time, we should not discount the advantages of remote medicine and look for ways to mitigate the disadvantages of such remote encounters. Remote medicine is a great way to reduce one of the main complaints of American patients: waiting time. Since patients are in their own environment either at their own homes or offices, doing what they normally do, this is an area we can see immediate improvement. We also have to look at favorably the productivity of the patient by not spending time in the physician offices or hospitals. In addition, exposure to infectious and contagious diseases will be minimized by remote medicine.

With respect to mitigation of lack of physical exam and touch and feel of the physician, there is no true replacement and serious patients must still be examined by the provider. But one way to mitigate the disadvantages of remote medicine is physicians have to better story listeners and better storytellers. Each patient is an open storybook. Physicians just have to read it. I am an advocate of replacing the age old medical school slogan of “History and physical” to “Storytelling and Story Listening”. The reason storytelling is important because in my experience I find that physician has his/her own story to tell first to make the patient comfortable. This is a great signal to a vulnerable individual that physician/ provider is a human and it is the best reassurance and encouragement for patients to open up about her/his own story.

In my own remote or person to person encounter, after initial introduction, I often start the interview by an open ended question, “Tell me your story……..” And this gives the patient on the other side of the line or sitting on the other chair to start with whatever they want. And often times people will start with something that is important to them or something that is bothering them the most. As the conversation starts, I find something of my personal life to share with them….. thus a patient’s story becomes one with a doctor’s story and it becomes a human story. By the time it ends, we both have an insight to our mutual connections as our doctor-patient relationship solidifies and a satisfactory treatment plan is built upon this solid foundation.

In my experience, patient satisfaction and compliance is far superior in this way. But this is also a self-service for the provider. Self-service because as providers we also need to feel content and satisfied about what we do and by doing it better. So this is a way to derive fulfillment about our own job. Most importantly, the intangible benefit a physician derives by connecting with her/his patients is immense, far beyond what money can buy.

So in the days of remote medicine and artificial intelligence, provider communities have to be far better storytellers and story listeners.

Followings are few examples how my patients told their own stories and at times even gave me away the diagnosis. In 100 percent of times though, they gave me an opening to their lives and a great way to connect:

1. A 48 year old woman; “How anxious I am to learn what is causing my pain. I have been on a liquid diet for more than a week, afraid of having another painful episode and returning to the ER”. This is in the background of upper abdominal pain.
2. A 66 year old woman: “I am getting too many chicken eggs!” This is after successful treatment of blockage of the esophagus.
3. A 59 year old female: “That my mother had a stroke in a catheterization lab and this procedures scares me because of that. But due to my faith, I believe that I’m going to be fine and back at my house eating chicken burgers, BBQ ribs, green beans etc!” This is in the perspective of a colonoscopy exam.
4. A 56 year male: “Get up in the middle of night with panic attacks when I can’t breathe. Using Wal-four Nasal Spray all day long”. This is in the background of an upper abdominal pain.
5. A 65 year old male: “My favorite color is blue, I love my wife more than life itself and my children are my strength. I need to exercise and eat better, I want to live as long as my great grand parents did at 103 and 105 years of age. I love life and believe in Jesus Christ who is with me today as I go through this procedure of life….. This is in the background of bleeding from colon.
6. A 18 year old male: “I like spicy food” This is in the background of reflux and upper abdominal pain.