DOCTORS' LOUNGE
DOCTORS' LOUNGE
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SMILE – YOU’RE ON DOCTORCAM! AUTHOR Mary Barry, MD
T
he risk of office contact with patients
now must be carefully calculated,
episode by episode. Are they actu-
ally and acutely sick? With what?
Need an urgent abdominal exam or
not? Need a lab or X-ray or not? Low
risk, but more than anything needs
the reassurance of our hands-on exam? Must
I (horrors!) tell them that the only safe advice is to head to the
emergency room? rashes. One unanticipated but good thing has come from COVID-19:
more adults than ever can locate a thermometer. I can get them to
take their temperature while I watch.
Enter: the video visit, aka telehealth, for those who do not make
the cut above. First: aim the camera down at you from a little bit above. Why?
“Cause boogers are secret!” and “We do not want to examine your
nose hairs.”
All day long we make these decisions. Working in the office
of Dr. Mike Needleman et al. in Okolona, we are blessed with an
office staff (Carla Heller in charge) of nearly all long-termers. They
know their patients inside and out. As of late March, we began a
two-doctor team with certain staffers in the office one week, then
the next week we all work from home: video and phone visits only.
Mike and I are on the A team (A for Age) and as you can see, we
are one powerful bunch.
Having always relied absolutely on close examination of the
patient, I feel handicapped by the safe distance of the camera. How
could I hear pneumonia, or effusions or wet crackles? How could
I look in an ear or tap on a belly or feel for nodes?
I have had to change this thinking. I can at least look in their
eyes, hear their voices, see down into their throats (the normal
airways) and ask them to do things to help me: cough, walk fast
on command, show me their medicine bottles and show me their
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LOUISVILLE MEDICINE
Setting up a video visit requires planning – the poor patient has
to endure tons of form-signing just to initiate one, and the med-
ical staff has to arrange what the patient will actually see (best to
move the joke skeleton out of camera range). Emily L. Hauser (@
emilylhauser) used to do media training for diplomats. She gives
great advice, especially for those of you who do this all day, from
home and from work.
Next: what is behind you should not detract or distract. You
must consider your skin color and your shirt color – they should be
different and contrasting (if you are Nordic, no pale walls or shirt).
The background should be visually calm and not detailed, not like
a mosaic. She points out that you are there to “inform/persuade”
and if your audience is trying to decipher the writing behind you,
you can do neither.
Next: Will your jewelry rattle, will your earbuds get tangled up,
are you well-lit? Is the camera set just enough above eye level so
that you can look at (and not down at) the patient, but they cannot
look up your nose? Once you are set up and seated, take a selfie so
you can duplicate what they see. (Hint: surgical masks are good at
hiding wrinkles, not to mention the chin wattle). You might have
to set your laptop on a stack of books, etc.
You want the patient to pay attention to you, not to anything