by Ariana Shaari*
A global pandemic transformed the way medical care is delivered nearly overnight. Telemedicine, generally defined as healthcare delivery without face to face contact, has crucial applications in the fight against Coronavirus – facilitating social distancing, easing the burden on physicians, and increasing accessibility to care, especially for providers and patients without adequate personal protective equipment (Luz, 2019). Telemedicine had a robust foundation before the pandemic and was quickly adopted to preserve crucial aspects of healthcare delivery. It’s roots are in the 19th century, when a physician first conveyed electrocardiographs over the telephone (Ryu, 2010). In the 1920s, radio consultations were used to provide medical care to patients in remote locations. In 2017, 70% of healthcare providers utilized telemedicine to connect with patients (Beaton, 2018). Today, telemedicine is saving the medical field. March telehealth visits increased by 50%. Virtual medical visits are expected to hit one billion by the end of 2020. Were it not for recent technological advances, the current pandemic, and medical care unrelated to Coronavirus, would be unfathomable.
Unsurprisingly, telemedicine has its limitations. Many components of medical care and the basic clinical exam are eliminated when physicians can’t palpate, scope, or auscultate. A growing personal concern is that patients may get so accustomed to the convenience of telemedicine that healthcare delivery will be permanently altered. I fear that telemedicine could erode elements of the doctor-patient relationship and affect measures such as patient satisfaction, medical outcomes, and physician burnout. Nonverbal cues may be missed on a video call; thus, crucial parts of a patient’s personal narrative can be missed. Telemedicine is doing more good than harm. Right now, it is essential.
It is still worth considering what is lost when bedside presence is replaced by a video camera. The power of bedside care is especially evident in the oil painting titled Self-Portrait With Dr. Arrieta (1820) by Spanish artist Francisco Goya. Goya’s career was marked with spectacular successes from the end of the seventeenth century to the beginning of the eighteenth century. Members of the Spanish nobility frequently praised his work, and he was elected and eventually nominated to direct the Royal Academy of Art in Madrid in 1795 (Felisati & Sperati, 2010).
Paralleling his successes, however, were a series of intense illnesses. His medical conditions impacted his life so severely that biographers often separate Goya’s work into two periods, “before and after his illness. The first characterized by joy and light, the second by horror and ghosts” (Felisati & Sperati, 2010). In 1792, he fell seriously ill for the first time with severe headaches, hearing loss, visual deficits, tinnitus, right arm paresis, and eventually depression and hallucinations (Felisati & Sperati, 2010). A similar onslaught of symptoms recurred in 1819. It is thought that the artist suffered from vascular lesions, lead intoxication, and syphilitic encephalopathy, resulting in severe personality changes, bouts of depression, and progressive deafness (Felisati & Sperati, 2010). Mercurial treatment is speculated to have exacerbated his neurologic symptoms. Eugenio Garcia Arrieta, an infectious disease specialist, was his personal physician who delivered not only medical care but also crucial emotional care during Goya’s lapses into acute illness.
The Self-Portrait With Dr. Arrieta is an intimate snapshot of the physician-patient relationship. Dr. Arrieta is positioned on the left, Goya on the right. Their interaction is a delicate balance between health and illness, support and collapse, caretaker and patient. The two subjects’ complement each other. Pink brush strokes highlighting Arrieta’s lips and cheeks contrast against Goya’s pale face. Arrieta, with a physical proximity more or less foreign to modern medical care, physically supports the collapsing Goya. Yet the painting’s relevance to the current pandemic is highlighted when focusing on the artist’s inscription on the bottom of the canvas:
Goya in gratitude to his friend Arrieta for the skill and care with which he saved his life in his acute and dangerous illness suffered at the end of the year 1819 at the age of 73. He painted it in 1820.
Goya describes Arrieta not as his doctor, but as his friend. In fact, the painting was a gift to his physician to thank him. Goya’s acknowledgement of his physician as his friend is a testament to the power of a positive physician-patient relationship. Yes, Arrieta cared for him medically, but by this stage in his illness, Goya was both delirious and deaf. It does not seem far-fetched to speculate that Arrieta’s physical bedside presence was a crucial emotional support. Arrieta nurtured Goya back to health over years, enabling him to exhibit his genius. Under Arrieta’s care, Goya went on to live another eight years. It is a portrayal not only of physical support, but also emotional support.
What qualities are missing when patients are treated through a computer screen? How much relationship building can occur between a patient and physician across the boundary of a computer? Could this impact long term care? Reflecting on the Self-Portrait in light of the global pandemic raises questions that will likely only find answers with time. For now, we have healthcare providers and telehealth to be thankful for.
*Author Bio: Ariana Shaari is a senior at Barnard College, Columbia University majoring in Psychology. Her love of literature and art history fuels her pursuit of a career in medicine.
Presently, she is sequestered in northern New Jersey. email: firstname.lastname@example.org
Armour, S., & McKinnon, J. D. (n.d.). Telemedicine Gets a Boost From Coronavirus Pandemic. Wall Street Journal. Retrieved from https://www.wsj.com/articles/trump-administration-expands-medicare-telehealth-program-11584461973?mod=article_inline
Beaton, T. (2018, June 11). 71% of Healthcare Providers Use Telehealth, Telemedicine Tools. Retrieved April 9, 2020, from https://mhealthintelligence.com/news/71-of-healthcare-providers-use-telehealth-telemedicine-tools
Felisati, D., & Sperati, G. (2010). Francisco Goya and his illness. ACTA Otorhinolaryngologica Italic, 264–270.
Francisco José De Goya Y Lucientes. (2011). Self-Portrait With Dr. Arrieta. Academic Medicine, 86(1), 114. doi: 10.1097/acm.0b013e3181ffa4d7
Luz, P. L. D. (2019). Telemedicine and the Doctor/Patient Relationship. Arquivos Brasileiros De Cardiologia. doi: 10.5935/abc.20190117
Martineau, P. (n.d.). iPads Are Crucial Health Care Tools in Combating Covid-19. Retrieved from https://www.wired.com/story/ipads-crucial-health-tools-combating-covid-19/?fbclid=IwAR1znny1fcjlg_sjvlXFFyukR6mIEiEjlD37ZBvA8ZQvfaKpoHV9VJV6byQ
Mims, C. (2020, March 28). ICUs Leverage Remote Doctors and Telemedicine to Manage Coronavirus Deluge. Http://Wsj.com. Retrieved from https://www.wsj.com/articles/icus-leverage-remote-doctors-and-telemedicine-to-manage-coronavirus-deluge-11585368006?emailToken=02205ff24ced1b5c2faaf330dc97ca2fP 5EDpBK8RK8gN bgrMaOcE0JVW YhaLNesVCB0Ge6/y/NGG3K2tDduc8DFCCVTeEusZ4Kxer3bnPvCoNRRbG03C/Cdy1aMEy8QtI1gZQRSHodnGA/4aCA2c6S/1UbwqGrU4puzPmrfm2O3p7ZEc Q==&reflink=article_imessage_share
Ryu, S. (2010). History of Telemedicine: Evolution, Context, and Transformation. Healthcare Informatics Research, 16(1), 65. doi: 10.4258/hir.2010.16.1.65
Ryu, S. (2012). Telemedicine: Opportunities and Developments in Member States: Report on the Second Global Survey on eHealth 2009 (Global Observatory for eHealth Series, Volume 2). Healthcare Informatics Research, 18(2), 153. doi: 10.4258/hir.2012.18.2.153
Stoll, J. D. (2020, March 26). Coronavirus Is Changing the Way We Say Goodbye to Loved Ones. Wall Street Journal. Retrieved from https://www.wsj.com/articles/coronavirus-is-changing-the-way-we-say-goodbye-to-loved-ones-11585234712
World Health Organization. Telemedicine: opportunities and developments in member states: report on the second Global survey on eHealth, Telemedicine: opportunities and developments in member states: report on the second Global survey on eHealth (2010). Geneva, Switzerland.
From Bhushan Kumar, Chandigarh, India” I must appreciate that you bring out very interesting material a related to the current scenario. This changeover from a touch sensitive medicine to mechanical and detached medicine is a vast change- which was happening slowly over years- but COVID-19 has put it in a fast forward mode. Nobody knows the end point- but for old timers like us- it is heart breaking and unacceptable. Touch, expressions and eye contact are essential to the practice of a meaningful and satisfying medicine.