The Art of Medicine After COVID-19

Early on in the COVID-19 pandemic, my ophthalmologist sent an email that he was offering “virtual eye exams” to his patients. But when I developed a serious eye problem over the Memorial Day weekend, I was advised that I couldn’t be treated on Zoom; despite a continuing “stay-at-home” order in Michigan, I had to come into the office, where the doctor was seeing urgent cases.

It was my first experience as a primary care patient in a world upended by the pandemic. I was curious from a personal and business perspective, wondering about everything from how the office would be cleaned and sanitized as patients cycled through it to billing procedures.

As someone who once covered the business of healthcare as a Detroit News reporter and also spent 20 years writing stories for hospital publications in the Detroit Medical Center, I wanted to know how COVID-19 is affecting the art of medicine at the primary care level, in a world already under threat by the corporatization of healthcare.

Before heading to the doctor, I received a list of instructions by phone on how to behave: wear a mask, enter the building through a specific door, and be prepared to answer a series of questions about whether I had been exposed to or had symptoms of COVID-19. I was nervous and packed a tote bag with extra masks, hand sanitizer, Clorox wipes and rubber gloves. I entered the office with a credit card and driver’s license in my gloved hand.

The receptionist stood several feet away from me and held up a scanner to take my temperature. She told me to put away my ID and credit card, a surprising development for a medical office that usually demands upfront payment for everything from routine exams to outpatient treatment.

In the waiting room were three chairs, instead of the usual 20. A trail of big Xs made with silver duct tape marked off the proper social distancing spaces on the floor. The two other patients eyed me suspiciously. I wiped down my chair before sitting.

When I got into the exam room, my doctor stood in the doorway, listening to my complaint and answering my written questions. The note-taking technician stood behind him in the hallway. The doctor then entered the room, swung the ophthalmoscope over my eyes and peered into them for a few seconds. He was all business.

“We need to do a procedure – and I think we should do it now,” he advised.

He led me to a separate outpatient surgery room, where he donned a face shield and a new set of gloves. His nurse, clad in a mask and goggles, held my hand as the doctor numbed up my eye with a series of injections, carefully avoiding my mask, and set to work.

When the 15-minute procedure was done, he scooted away and gave me follow-up instructions from the doorway. I thanked the doctor and the nurse for being available to their patients. They, and other front-line workers are true heroes risking their own lives to help others.

As I left, I made a mental note to monitor myself for any COVID-19 symptoms during the next 14 days. The receptionist would not accept my credit card for the co-pay, and waved me toward the exit. “We’ll bill you,” she said.

My experience was as reassuring as possible that afternoon, but much more rushed and impersonal than usual. Definitely more “science” than art – and that made me concerned about the future of the doctor-patient relationship.

Writing in the American Journal of Medicine in 2017, Joseph Mambu, M.D. discussed “Restoring the Art of Medicine,” noting “each patient experience presented me the opportunity and obligation to blend my personality, my core values and my sense of humor with what being a physician meant to me.” He wrote about the necessity to consider the “whole person” when dispensing a healing touch. My experience that day taught me that neither the doctor nor I wanted to spend any time beyond medical matters. Get it done, and get out.

With that in mind, will doctors have the luxury of practicing the art of medicine or honing their bedside manner in a post-COVID world? Or has that become another victim of the pandemic? Will they have time to notice other maladies, or have the time for small talk that may uncover concerns about mental health or underlying conditions?

Later that day, I developed another medical issue: I broke a tooth while eating dinner. I called my dentist, who had left a long recorded message on her office phone. She was adhering to the Michigan governor’s stay-at-home orders until May 29 and would not be seeing patients until the lockdown lifted, unless they were experiencing “pain, swelling or infection.” I decided to take a Tylenol and call back later. I wasn’t ready for another face-to-face visit. One foray into the strange new world of medicine in one week was enough for me.