A few weeks after shelter-in-place took effect, I received an unsettling call. It came from a patient I’d met during my last rotation before medical school was suspended. “I’m on the verge of a mental breakdown,” he said. Why call me, a medical student? Turns out, his psychiatrist was unavailable because she was in the middle of transitioning her physical practice to telemedicine.
After delivering my usual advice (e.g., maintain proper exercise and sleep schedules, eat well, build a support network of friends and family, try meditation, moderate intake of media), we ended up chatting about the novel he was writing, his backyard garden, and his wife’s music career. By the end of the hour, he thanked me and reassured me he was feeling much better. That’s when I realized the tremendous potential of telemedicine, even for medical students, in the time of COVID-19.
Ever since mid-March, when the AAMC recommended that medical students stop seeing patients, we have been struggling to figure out what all this means for our education. Medical licensing exams have been postponed, academic conferences have been canceled, and a lot of students, forced to take leaves of absence, are worried they won’t graduate on time. Even so, it’s clear many want to help with the crisis.
Student-led initiatives have cropped up in medical schools around the country — to create COVID-19 educational material for patients, help counsel patients remotely, host PPE donation drives, and assist with health care workers’ day-to-day needs. Still, epidemiologists are increasingly certain COVID-19 outbreaks will recur in subsequent waves, posing continued disruptions to medical education.
Fortunately, most hospitals and clinics across the country have rapidly expanded their telemedicine capabilities. Federal agencies have promoted this by increasing funding and loosening regulations, while local governments have helped by broadening internet access. Doctors themselves acknowledge that telemedicine will play an increasingly greater role in health care in the post-COVID-19 world.
Medical schools should start implementing modules into their curricula to teach students telemedicine now, and let us take on a more active role in patient care during these difficult times.
In reality, this would not be that radical of a departure from what medical students were already doing. When we assist doctors during rotations, we have far less knowledge about the specifics of disease management than our supervising physicians. But what we lack in clinical knowledge, in our authority to prescribe medications, and in our ability to handle a large number of patients, we make up for in our time and availability.
On rotations, I often got to know my patients far better than my supervising physicians could. I would find myself spending hours with hospitalized patients while the physicians rushed to finish medical notes, order tests and medications, and call for consults. It wouldn’t be an exaggeration to say that helping patients pass lonely stretches during the day, hearing their stories and exploring their worries, were my greatest contributions to the care they received.
At Stanford University School of Medicine, I created and direct a curriculum that gives medical students the tools for communicating and building relationships with patients who are facing serious illnesses. Students learn how to uncover and address patients’ emotional, psychological, and spiritual concerns. Notably, these pre-clinical students do not require a command of specific disease management strategies to effectively help patients. I’ve witnessed students’ ability to pick up and implement the principles involved; I know they would be able to apply those principles just as well in video encounters. Indeed, during telemedicine patient encounters, medical students need not offer medical advice — that would be the job of the physicians. Instead, they would focus on addressing patients’ other concerns. Studies have shown that epidemics and associated lockdowns co-occur with psychological stress brought on by fear, confusion, anger, boredom, and frustration, often over inadequate or conflicting information. Even after shelter-in-place orders are lifted, our social lives are still going to be fragmented. Data further suggests these emotional challenges may remain long after a pandemic has passed or, more ominously, may not appear until the threat is long gone. Since current recommendations suggest that older patients and vulnerable groups remain in some measure of social isolation after lockdowns are discontinued, they will be especially susceptible to the associated emotional repercussions.
Obviously, telemedicine will not be equally appropriate for every specialty; it will undoubtedly, for example, have less utility in gastrointestinal surgery than psychiatry. However, at the medical student level, participating in these virtual meetings with patients can sharpen skills that would improve us as clinicians, regardless of specialty. We can all improve in areas like compassionate communication, patient-centered care, and reflective practice.
Telemedicine isn’t going away after the current outbreak. Medical schools should start acquainting students with this new normal. But telemedicine might, somewhat paradoxically, be offering us opportunities to improve our capacity to nurture the physician-patient relationship. And, with COVID-19 chaos threatening the public’s confidence in medical experts, training a future generation of doctors to better connect with patients just might be one of the best things to do.
Henry Bair is a medical student at Stanford University, where he directs a curriculum for medical students on communication techniques in the fields of geriatrics, palliative care, and end-of-life care. He is also a research coordinator at Stanford Medicine’s Center for Policy, Outcomes, and Prevention, and a medical consultant at Covid Act Now.