I think I’m getting the hang of conducting virtual consults. And I feel like some of my patients, once we get past the clunkiness of the synchronized “Can you hear meeah?!”, are getting used to it as well. I haven’t had anything anxiety-inducing happen during consults so far, like someone getting a seizure live, although I still get shookt when patients, (usually the grandmas) would just rip off their shirts to flash their breasts without warning.
I’ve been trying to innovate on physical examination, asking them to palpate their own necks and telling them to describe to me how the mass feels. All of a sudden I am an instructor teaching Physical Diagnostics– the forehead is hard, the nose doughy. Certain instructions sound terrible when taken out of context, such as “Sige kapain mo pa, sige pa, matigas?!” or “Touch your balls.” At some point I can only try to guess what is happening, the tele- in teleconsult actually meaning telepathy. Hulaan portion.
The physical examination is the easy part. Disclosure of diagnosis and prognosis, explaining the effects of chemo, and trying to give comfort are more challenging to do through the screen. The soft elbow touch, the upper back rubs as you explain that the cancer has metastasized to the bones, can no longer be given. As we do this more often, and as the quarantines extend longer and longer, we will definitely become more adept at this. I’m pretty sure the art and science of bedside care has evolved through the years, and we have no choice but to evolve with it.
I have long resisted the urge to buy a ring light for use in video consults, but I’ve seen action figure dioramists using it for their toy photography so I just might get one!