Telemedicine and rheumatology: Where is empathy in the digital encounter?
Click Here to Manage Email Alerts
If there is one thing that is clear, it’s that telemedicine is here to stay.
This month’s roundtable with Daniel Albert, MD; Elizabeth Ferucci, MD; Christine Peoples, MD; Jasvinder A. Singh, MBBS, MPH; and Alvin F. Wells, MD, PhD, is an authoritative overview of the prospects and challenges of how telemedicine may look in our future care models. Despite progress in telemedicine, there are many unknowns, including exactly how it will look or how it is affecting health outcomes. Another concern of mine is how digital care can potentially threaten the relationship between practitioner and patient — and if this is a risk, considering ways of avoiding such.
The dominant medical paradigm of the past century has been one of growing biomedical advances and the emergence of precision medical practice with the goal of accurately diagnosing and curing disease. Less emphasis has been placed on the concept of illness, which is the personal experience of disease. However, I am proud to say that there is a move afoot in our profession, which I have discussed from time to time, of “dual targeting,” designed to meet our patients’ needs by addressing not only their complaints, but also their concerns.
If you embrace this approach as I do, then the relationship between the practitioner and patient is more vital than ever.
Enter the digital visit, which, as our discussants point out, offers many advantages and efficiencies but so clearly and literally has increased both the physical distance as well as potentially the existential distance between the dyad of practitioner and patient. I have written in these editorials many times regarding the power of empathy in clinical practice as a force that not only brings a higher level of satisfaction to the encounter, but also may contribute to the healing of illness.
Accordingly, I think it’s reasonable to question how digital visits may limit the expression and communication of empathy, as it is estimated that perhaps 80% of empathic communication may be nonverbal. The facial muscles that may denote stress, the tenor of the voice, the posture and other clues that may — or may not — be obvious when we are seated next to a patient can easily be missed across the digital divide.
I have no easy answers, but I am strongly advocating for more research in this area and for openness in our collective willingness to learn new types of communication skills not offered, or even existing, in our own training. At the Cleveland Clinic, Sylvia Perez-Protto, MD, MS, the medical director of our End of Life Center, who I like to refer to as an empathy ninja, offers many tips on maintaining and expressing empathy during digital encounters — see her discuss “The Importance of Expressing Empathy Through Telemedicine” on YouTube.
Among these tips is noting the emotion you may be hearing and seeing from the patient — ie, she is sad, he is angry or depressed — using the right tone of voice for the situation, embracing pauses and letting the patient react or respond as they need.
Although we are only starting to explore the power of empathy in medicine in general, we are at the beginning of the beginning of exploring it in digital medicine. I look forward to working in this space and am now engaged in a project exploring empathy and artificial intelligence in medicine. This month I offer no easy answers but a clarion call to think about empathy when we log in. That’s my take — please share yours with me at calabrl@ccf.org or at rheumatology@healio.com.
- Reference:
- Perez-Protto S. The Importance of Expressing Empathy Through Telemedicine. YouTube. https://www.youtube.com/watch?v=pt1fgCxLp_c.
- For more information:
- Leonard H. Calabrese, DO, is the Chief Medical Editor, Healio Rheumatology, and Professor of Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, and RJ Fasenmyer Chair of Clinical Immunology at the Cleveland Clinic.
Collapse
Read more about
Click Here to Manage Email Alerts