Read on Twitter
In the 1930s about 40% of all doctor visits were house calls (the physician went to the patient’s house to see them).
By the 1980s it was down to 0.6%.
“The past beats inside me like a second heart.” - John Banville, “The Sea.”
1/
By the 1980s it was down to 0.6%.
“The past beats inside me like a second heart.” - John Banville, “The Sea.”
1/
The year is 1932.
The doctor steps from the car and walks down the alleyway.
This is the last patient he has to visit for the day. His bag is clutched in a tight grip as he ducks down a side alley.
The stench hits him hard here, and he holds a handkerchief to his nose. 2/
The doctor steps from the car and walks down the alleyway.
This is the last patient he has to visit for the day. His bag is clutched in a tight grip as he ducks down a side alley.
The stench hits him hard here, and he holds a handkerchief to his nose. 2/
“Respiratory difficulty” is what the note on his schedule says. As the doctor makes his way deeper into the slum, he can understand why.
A nearby factory is belching a toxic cloud of black smoke into the sky.
A thick layer of soot and grime covers the brick walls here. 3/
A nearby factory is belching a toxic cloud of black smoke into the sky.
A thick layer of soot and grime covers the brick walls here. 3/
It is unusual for a doctor to be seen in this place.
He can tell, by the curious and suspicious looks he is getting from people in the alleys, that law enforcement would be a more likely role for a stranger.
He finds the tenement, and knocks on the door. 4/
He can tell, by the curious and suspicious looks he is getting from people in the alleys, that law enforcement would be a more likely role for a stranger.
He finds the tenement, and knocks on the door. 4/
Housing here is cramped, poorly ventilated, dimly lit, and with minimal plumbing.
The door opens and a little girl stands before him. She gives him a crooked smile, and he notes the dark discoloration of her teeth.
Impurity in the water, or the very air itself?
He enters. 5/
The door opens and a little girl stands before him. She gives him a crooked smile, and he notes the dark discoloration of her teeth.
Impurity in the water, or the very air itself?
He enters. 5/
As his eyes adjust to the darkness he realizes there are many more people than he expected to find in here.
He nods a greeting, stepping from the hallway into the kitchen / living room / nursery.
The air is thick, stale, reeking of smoke and lingering despair.
He coughs. 6/
He nods a greeting, stepping from the hallway into the kitchen / living room / nursery.
The air is thick, stale, reeking of smoke and lingering despair.
He coughs. 6/
Everyone has cleared out of the room where the sick woman lies in bed.
He enters quietly, nodding a solemn greeting to her husband who sits on a chair beside her.
Before he begins, the doctor lets his gaze wander across the room.
Small pieces of art decorate the walls. 7/
He enters quietly, nodding a solemn greeting to her husband who sits on a chair beside her.
Before he begins, the doctor lets his gaze wander across the room.
Small pieces of art decorate the walls. 7/
It is in this moment, that the doctor crosses a threshold, as he looks at the beautiful detail in a stitched scarf hanging above a window.
He has entered the world of his patient.
This building, this flat, this room, and the hopes and dreams it contains.
This life. 8/
He has entered the world of his patient.
This building, this flat, this room, and the hopes and dreams it contains.
This life. 8/
When she coughs, she brings up bright red blood. She looks frail.
The doctor understands that the prognosis here is bleak.
He sits, and sets his bag down on the side table. Opening it, he takes out several small bottles.
And he asks her about her art.
She smiles. 9/
The doctor understands that the prognosis here is bleak.
He sits, and sets his bag down on the side table. Opening it, he takes out several small bottles.
And he asks her about her art.
She smiles. 9/
The year is 2020.
The COVID-19 pandemic is bringing changes to every aspect of life.
My clinic practice has become primarily telemedicine.
My patients who have the ability and resources to use a video app on their phone or a computer can do so.
I phone-call everyone else. 10/
The COVID-19 pandemic is bringing changes to every aspect of life.
My clinic practice has become primarily telemedicine.
My patients who have the ability and resources to use a video app on their phone or a computer can do so.
I phone-call everyone else. 10/
At first I instinctively rebelled against visits where I couldn’t look into a patient’s eyes. I had a hard time feeling like I was “connecting,” especially with new patients.
But gradually I’ve realized how subtly a dynamic has shifted.
The space has changed. 11/
But gradually I’ve realized how subtly a dynamic has shifted.
The space has changed. 11/
Instead of driving to my office, checking in, sitting in the waiting room, walking into a blandly sterile exam room, and smelling that recognizable “medical” scent of disinfectant; my patients are in their homes.
We are now meeting in their comfort zone.
Smiles are bigger. 12/
We are now meeting in their comfort zone.
Smiles are bigger. 12/
I realize that in a strange way, I’m moving through time to a different era.
When I “ring up” a patient, it’s like a digital knock on a digital door.
Depending on how their camera is positioned, I often get a glimpse into a world I would never see otherwise.
Their home. 13/
When I “ring up” a patient, it’s like a digital knock on a digital door.
Depending on how their camera is positioned, I often get a glimpse into a world I would never see otherwise.
Their home. 13/
I’ve seen musical instruments in the background, and watercolor paintings, and wood carvings, and pet dogs, cats, fish.
I’ve seen their relatives, and their refrigerator contents, and their dining rooms, and living rooms, and patios, and back yards.
Even motorcycles. 14/
I’ve seen their relatives, and their refrigerator contents, and their dining rooms, and living rooms, and patios, and back yards.
Even motorcycles. 14/
It will never be the same as an in-person office visit: I don’t have the ability to empathize and connect as much as I’d like, and my physical exam is obviously limited.
But in giving up these things, I’m gaining something else.
Context. 15/
But in giving up these things, I’m gaining something else.
Context. 15/
Instead of the patient being a stranger in a strange land, I’m the stranger.
Knocking on the door, asking permission to enter their world. Through the lens of a camera, I finally see.
I’m with them.
A paradox:
Social distancing brings me closer than I’ve ever been. 16/
Knocking on the door, asking permission to enter their world. Through the lens of a camera, I finally see.
I’m with them.
A paradox:
Social distancing brings me closer than I’ve ever been. 16/
“I live my life in widening circles that reach out across the world.”
- Rainer Maria Rilke
(“Health-Care” by Leon Zernitsky, 2014)
- Rainer Maria Rilke
(“Health-Care” by Leon Zernitsky, 2014)
