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Dr Schuman, section editor for Peds v2.0, is clinical assistant professor of Pediatrics, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, and editorial advisory board member of Contemporary Pediatrics.
The COVID-19 pandemic has been fraught with worry, depression, and sadness. It's a very difficult time, but a smile can still make a world of difference.
For patients, parents and pediatricians, the COVID-19 pandemic has been a surreal experience. In March of this year our society changed abruptly. Families were advised to stay home, and pediatricians quickly altered their practices to help safeguard staff and patients.
For over two months I’ve been practicing telehealth exclusively at home. I did so with the support of my partners, as I have risk factors which predispose me to more severe consequences from SARS-CoV-2 infection. Just recently, I emerged from seclusion, fearful, but eager to return to office practice. Following my return to the office, I’ve made some observations about pediatric practice worth sharing with our readers.
For months, as health care workers, we have been doing our best to care for patients in the midst of a pandemic. Without a means to diagnose COVID-19 at the point of care, treat suspected COVID-19 cases with a proven antiviral, and lacking an effective vaccine, we could do little to help patients with the crisis. Our battle plan included modifying our routine to implement telehealth services, triaging patients, using personal protective equipment (PPE) to see patients, and seeking loans to keep our offices afloat financially.
Telehealth during a pandemic: Lessons learned
While practicing telehealth at home, I quickly realized that parents and children were quite worried. Schools were closed, parents lost jobs, and life was now unsettling. Although most parents did their best to reassure children, I discovered that face-to-face video visits were a welcome experience for everyone. Sheltering in place, it seems, makes one keen for human interaction, and families appreciate when words of encouragement come from someone familiar. I knew my patients and their interests, and our telehealth visits were fun. I could joke about a patient’s long hair and ask how they were doing with their online classes. Like most pediatricians, I easily recalled the nuances of the lives of my patients and families. It was easy to ask about hobbies, parents’ jobs, and the whereabouts of older brothers and sisters who had aged out of the practice. During the visit I could smile at parents and patients, and receive warm smiles in return, while reassuring them that together we would get through the pandemic, and perhaps be better in many ways for the experience. No matter if the virtual visit was for an attention-deficit/hyperactivity disorder evaluation, or an acute visit for a fever and cough, the telehealth visit was effective, and in many ways better than an office-based visit. After all, there was no travel involved, patients did not need to be roomed by a nurse, and as vaccinations were never administered, visits were pain free. I was in my “safe space” and the patient was in theirs. I usually wore pajamas, and a hat to cover my-too-long-hair- needing-a-haircut, and my patients and parents were similarly attired. Showering (and shaving) became optional.
At the virtual visit, I soon came to realize that the most rewarding part of the visit was to see another person’s smile! Sheltering in place does make one appreciate the little things. More than hand sanitizer and toilet paper, sharing a smile is one of the true blessings of being a pediatrician. It took no less than a global pandemic to make one appreciate the importance of a simple smile.
Back to work
Once back in the office, it was clear that resuming well-child exams would not be easy. No matter whether one wears full PPE for these visits or a face mask and shield, with parents and patients masked as well, conversations between exam room occupants is difficult. It is near impossible to share a smile and also difficult to do an examination so attired, and I do not remove a patient’s mask to examine the mouth or throat unless it is necessary. Young children unable to wear a mask are sometimes intimidated by the funny looking person doing doctor stuff, who sounds like that nice pediatrician he or she has seen before. Until such time that we can safely unmask—I now try a little harder to make my patients and parents laugh or giggle to make the office visit comforting.
Although the pandemic curve is flattening, there continues to be widespread COVID-19 cases in my community. Until the crisis is behind us, I suggest that front office staff and office nurses communicate with families via video visits whenever possible. Hopefully we will soon be able to greet families with a smile, a welcoming handshake and a warm hug.