When I started my training as an emergency room physician, my mind revolved around answering one fundamental question: What does this patient have? Every interaction was a diagnostic puzzle, an attempt to fit a patient’s symptoms together into a cohesive picture.
But human beings are complex, and the ways people feel and describe their symptoms don’t always follow what medical students learn in textbooks. When I couldn’t figure out a clear cause for my patient’s symptoms, I would settle for answering the next best question: Does this person have anything soon to be life-threatening that needs to be diagnosed today?
If the patient’s tests came back normal, that could have been reason enough to release them from the hospital. I could present their results as objective reassurance.
As the pandemic took off, though, my hospital began expanding virtual urgent care. I knew that these video visits would be easier for sick patients who didn’t want to leave the house, and further the public health goal of reducing people’s exposure to infectious diseases. But I always thought tech-enabled conveniences would be at the expense of human connection.
It turned out I was wrong. Through the screen, I found something unexpected: the chance for technology to offer a different — and sometimes deeper — interaction with patients.
At first, I balked at telehealth shifts. Tests and X-rays weren’t readily available for video visits and patients typically called in without any vital sign measurements such as blood pressure or oxygen level. It seemed impossible to care for someone without even this most basic information.
More than that, I was resistant to replacing any in-person interactions with a remote video interface. If anything should be immune to the cold detachment of technology, it’s medicine.
But as I started doing video visits, my perspective shifted. Emergency rooms are chaotic places. When I’m speaking to one patient, other patients also need my attention — as do their family members, nurses and administrators, residents and students. Rarely do I get to finish a conversation without being interrupted.
Over video, though, the interaction is surprisingly intimate. It’s just the patient and me, face-to-face, without any disruptions. It’s quiet — and when it’s not, it’s because something is happening on the patient’s end that allows me a glimpse into a life. I’ve met new mothers while they’re trying to soothe their crying babies. I’ve had people call me from noisy shelters. I’ve seen older patients resting in bed, surrounded by the chatter of family members.
I also learned how much the medicine isn’t about testing and diagnosing.
Over a recent virtual visit, I met a young woman who had struggled with various gastrointestinal symptoms and had seen several specialists. She had received far more testing than I could ever have offered her, even in the E.R. Why would she book a telehealth appointment with me, someone who would certainly know less about her case than her specialists and primary care doctor?
But in this virtual setting — without the availability of blood work and scans — I started to think about a new question: What does this patient really need?
I listened to her symptoms and reviewed her medical record with her. I didn’t know what she had, but I didn’t think she needed to rush to the hospital. She looked well, and none of what she was experiencing was different. There were no new data points to fill in her chart. She was no closer to a diagnosis. I could not tell her anything that she didn’t already know. The visit felt unsatisfying.
At the end of the video visit, I thought she might tell me the interaction was a waste of time. But, instead, she expressed gratitude. “In my head, I already know all of this is true, but I just needed to hear you say it out loud and talk through it with me,” she said.
I had always assumed that technology would only widen the distance between doctors and patients. I know other physicians like me who’ve long believed that in-person patient interactions could never be replaced — and, in many cases, they can’t be. But the pandemic allowed doctors to drop into our patients’ living rooms, their kitchens — directly into their everyday lives. That interaction, even through a screen, could feel, surprisingly, quite meaningful.
This is far from an unabashed endorsement of technology’s integration in medicine. Some enthusiasts believe tools like artificial intelligence can increase physicians’ time with patients by handling tasks like filling out electronic health records, writing letters to insurance companies or even becoming partners in diagnosis. While many of these innovations are being put in place, often for the sake of efficiency, their broader effects on the patient-physician relationship remain unknown. I still fear that technology might continue marching forward without the great care and scrupulous intention it requires.
For now, though, on the days I see patients in-person in the frenzy of the E.R., I find myself reflecting on what I learned from those virtual visits. To see beyond the diagnostic puzzle to what the person really needs. This gives me cautious hope that thoughtful, careful use of technology could restore some of the soul of medicine we’ve lost along the way.
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