In 2011, American physician and author Abraham Verghese had famously introduced the power of the human hand — to touch, comfort, diagnose, and bring about treatment — as the most important innovation in medicine in the next ten years. It remains so still even though the invasion of the COVID-19 virus has altered the dynamics between a doctor and patient to a large extent; the core idea remains to “only connect”, if not in the physical space, then indeed in the virtual world.
It is that touch that makes the patient-doctor encounter humane, and it helps, heals, and cures. Verghese highlighted that the ritual of physical examination is cathartic to the physician and necessary for the patient. Noida-based medical oncologist Dr Yogesh Kumar Nishchal has been a strong advocate of the ritual, but COVID-19 made him avoid face-to-face consultation altogether, giving the physical examination a complete miss. “In the physical space, I would always examine the patient but it is one thing that we doctors had to do away with due to the pandemic. Our interactions are only telephonic/video,” feels Nishchal.
The tele/video consultation saves precious time and money for patients as there is no travel involved apart from ensuring the safety of both patients and doctors. Dr Arvind Sachdeva, who runs a clinic in Gurugram, found it convenient at times, but equally challenging in many measures.
“It is indeed easy to consult over a call or video, but many times, a physical examination is required and without which diagnosis becomes a tad difficult. We have to rely solely on a series of test results to advise medical treatment,” she rues, adding how she is still trying to get a hang of scanning and sending prescriptions over phone/email.
Prevention is better
COVID-19 safety guidelines made touch out of bounds for both the patient and doctor, but certain specialities like dental, gynaecology, etc. couldn’t do without it. “Over the last 15 months, I have learned to live the video way. But treating without touching is difficult in dental. Once a patient had a severe toothache, and I had to guide her on a video call on how to apply local anaesthesia gel and numb her tooth to be off the searing pain,” recounts Dr Sweta Bajaj, who runs her dental clinic in New Delhi. On the other hand, Dr Monica Sachdeva, Medical Director & Senior IVF Consultant, PRAVI IVF & Fertility Centre, in Kanpur, complains how COVID-19 has reduced the normal patient load as a result, the time devoted to a patient now is more compared to that in the pre-COVID era.
“Bypassing the ritual of physical examination leads to less satisfaction among the patients. The biggest challenge was making a correct diagnosis based on history alone as well as protecting ourselves and fellow patients from the infection. We had to take many precautions and follow safety protocols. Frequent hand washing, proper sanitation around the IVF centre, social distancing, wearing PPE and minimising gatherings and unwanted travels and outings were the cornerstones of the safety measures followed by me,” says Monica.
Adapting to the new normal was easier said than done. “The worst part of these online consultation has been the helplessness to see a patient writhing in pain, and advise medications to reduce it without being able to see the exact condition of the tooth,” Bajaj adds, who encourages her patients to follow some protocols like sending full a COVID consent form with details of complete travel history, fever, allergy, etc, before meeting them in the clinic in emergency cases. Even though constant sanitisation has spoiled her hands, and frequent fumigation leaves her choking, she insists on diligently following these measures to ensure the safety of herself, staff and patients.
Gift of presence
The ritual of checking the pulse, touching the hands, and looking at the nail beds, then tongue, pulling down the eyelids, percussing the chest, and tapping the abdomen, have all been completely lost to COVID safety norms. “I have been doing it for all these years, but now suddenly, we are dependent on technology to come to our rescue and salvage the situation. I prefer to do a thorough physical exam in a face-to-face meeting with the patient. I felt that I was short-changing my patient by not being able to do it during the online consultation,” says Arvind.
Mumbai-based Pooja Ramchandran, Vice President — Genetic Counselling, Mapmygenome India Limited, who is a genetic counsellor with expertise in medical genetics and psychological counselling, has been doing online consultations for patients across the country (and the globe) for a few years now. She feels that telemedicine is helpful in increasing access to genetic counselling services that can often be challenging to find. The pandemic saw a steep rise in her consultations.
“Earlier 30-40% of my appointments were conducted digitally or telephonically, but now I am close to 100%,” she says, adding how genetic counselling relies heavily on communication (verbal and non-verbal) to make psychosocial assessments and implement the right interventions.
“Genetic counselling appointments exclusively through the phone/video can be slightly limiting with regards to making accurate assessments of non-verbal communication and dynamics between couples/families. It makes me push myself harder, and check in more frequently with patients to ensure we’re all on the same page while facilitating critical decision-making for healthcare,” she says.
The pandemic widened the physical gap between the patient and doctor, maybe the duo isn’t as close to what it was like during the pre-COVID times, but they share a close relationship. “The lack of in-person meetings led to less bonding but then, we found a way to connect. One of my breast cancer patients and I share similar hobbies. Earlier, whenever we used to meet, we used to talk a lot about our hobbies, but now she shares her works via videos with me,” says Nishchal.
Like all other doctors, healthcare professional Ramchandran too feels that while it is possible to establish a good rapport in virtual consultations, it is hard not being able to share space, shake patient's hand during introductions and goodbyes, or give them a pat or a hug or a tissue when they're struggling. “I love that we can continue providing and having access to world-class genetic counselling services and staying safe and alive,” she says.
Other doctors couldn’t agree more with her even though yearning for life to return to normal soon. “After all, it's better to be safe than sorry,” says Arvind, who as a matter of habit regularly calls or texts her patients to check on them.