They say it’s darkest before the dawn – the scramble for vaccines has brought us into a pre-dawn country-wide depression. You would be forgiven for thinking it was 1845 and someone had just ripped the first black potato from the ground. Stay strong, Ireland, we’ve plenty of potatoes, and more on the way. We’re nearly there, and guess what? You get to shape a new beginning, you’ll be making chips with those spuds before you know it!
What new world will we build? As a regular patient, I am often lolling about hospitals talking to people on the frontline, and it looks like the building has already begun.
During the height of this country’s first lockdown I found myself in hospital. I had some apprehensions as to what a HSE hospital in the grips of a virulent killer might look like. Covid was ripping up the script and the new face of healthcare was, well, no longer a face. The hospital was wall-to-wall masked crusaders. People were either snapping on rubber gloves or slathering themselves in hand sanitiser.
The reduced physical presence in the hospital was palpable. The long, empty weekends during the pandemic were the hardest for me, the time passed so slowly with no visitors allowed.
One evening a hospital porter, a salt-of-the-earth Dublin gent, was wheeling me from the cardiac ward to the stroke unit.
“You know the way people have terrible fears, their worst nightmares?” he said.
“Ya know, like snakes or drowning or prison. Well my worst, absolute WORST, nightmare is a global viral pandemic! I’m not messin’, I’m in BITS with this corona thing. As soon as it came out of China I had a full-on nervous breakdown for two weeks!”
As we wound our way in the dead of night through a designated Covid hospital passing by ICUs, CCUs, stacks of PPE peeping out of presses, he concluded: “I’m grand now though. Still n’all… Jaaaysuz, wha’?!”
I still think back to that ‘Jaaaysuz’ moment and smile. By now, we’ve all had our ‘Jaaaysuz’ moments.
From the porter to the practitioner, I’ve talked to them all. I had an enlightening conversation with Dr Rory O’Donnell, consultant respiratory physician in St James’s Hospital and one of the few doctors left in the health service who hasn’t treated me directly. He didn’t punctuate his sentences with ‘Jaaaysuz’ but the fascination with our current situation was the same.
“Early on we knew that the traditional clinic structure of waiting rooms wouldn’t work, so we started telephone outpatient clinics. Although the concept of remotely reviewing patients was not a novel one, for respiratory physicians in our department the approach was new.”
The word ‘new’ struck a chord with me, what future lies ahead for us all in this new world? Our awareness of our bodies and minds, and how precious they are, is visceral right now. We are never going back to how it was, but where are we heading in terms of care – telemedicine? Dr O’Donnell noted the advent of Covid had forced a rapid but timely leap forward in work practices.
At this point, virtually the whole nation has spoken to a doctor or nurse on the phone/Zoom. I think it works wonderfully for minor ailments and routine check-ups, no travelling to appointments or sitting on plastic chairs for hours on end. In my own patient experience of ‘virtual appointments’, I find it much easier to rattle through my questions relaxed in my own surroundings.
Also, the visual clues a doctor may traditionally give that the appointment is over, such as standing up, walking to the door, calling you a taxi… all those sledgehammer signals were not there.
O’Donnell has also observed a shift. “Until recently, the doctor appeared to ‘hold court’ in a busy office, patients were obliged to arrive on time, not to do so risked losing their slot altogether. On the other hand, during a telephone outpatient appointment the patient is at home, where they feel most comfortable. Now it is the doctor’s responsibility to contact them.”
I discussed the downsides with him, the most obvious being no physical examination – which is unsatisfying for all involved. I can talk with the best of them but when I feel seriously unwell, I won’t say much more than “I’m grand” (which every Irish person knows is code for ‘drop it’).
Dr O’Donnell highlighted other caveats. “An admonition to stop smoking is less weighty when delivered over the phone – and seems somewhat rude. Also, a doctor can often sense that ‘something is up’ in a single glance from breathing pattern, demeanour, tremor or simply a lack of eye contact. Now the patient has to communicate effectively using only their speech, a tall order in the acutely unwell. In one instance I rang a patient after a six-month interval to discover the frail voice at the other end of the line now belonged to a dying man, lying in his hospice bed.”
Despite talk of death we finished on an optimistic note (as Irish people often do): O’Donnell, who deals with complaints for a living, believes business is conducted quite efficiently at telephone clinics and the advantages to the patient are so significant they will become standard practice.
As a patient, I believe telemedicine will cut the time suck, it will shorten waiting lists, it will protect the vulnerable against raging viruses, but it’s not the sole solution.
I’m hopeful, the vaccines are coming, they will be that delicious burst of fresh bright sunrise, the dust of gold that will vanquish our dark night. The butter to put on the potatoes. I feel we are in the throes of constructing a blended approach between in-person and remote care that will strike the right balance for all. Well, not all, because you can’t keep everyone happy all of the time – we’re still going to falter, we’re still going to rail, we’re still going to have our ‘Jaaaysuz’ moments… but we’ll do it together.