Sitting at my desk at work, caught up for the moment from messaging patients, I found the opportunity to take a breath and reflect on everything going on around us. As the COVID-19 pandemic continues to spread, we are following the recommendations that only patients with urgent or emergent problems be seen in our offices. This generates a significant number of phone and electronic communications, but also limits what we can do for patients when we are in physical contact with them. Not being able to perform a physical exam of some type runs counter to my training.

In medical school, we were taught that 40% of the time you can diagnose a patient by history alone, but another 40% require a physical exam. The remaining patients are either diagnosed by testing or go undiagnosed. In truth, over time that has evolved to 40% history, 20% physical, and the remainder by testing. When you are talking to someone and watching them on a camera, you can see some things, but the perspective is flattened and lighting difficult. Sometimes, you just have to run your hands across that rash, or feel how soft or firm that lymph node is. Trying to diagnose any ear problem, throat problem, or abdominal pain is definitely challenging.

But these are challenging times. What had become our standard of care in evaluation and management of patients is now evolving. We are re-evaluating our opportunities to perform what is best and trading it for what is best right now. Medical professionals are masters of determining risk-benefit ratios and treating patients based on those assessments. None of us were quite ready for a viral pandemic that limits our ability to evaluate. The oath to “first do no harm” takes on a different slant when asking a high-risk patient to do something as simple as get blood work done at the lab. The patient is now at risk simply from traveling to and from a healthcare facility. Previously, when starting a patient on a medication that has a slight chance of causing damage to their kidneys, I would want to know exactly what the kidney function was and then I would decide if it was worth the risk. Now, I also have to decide is it worth the risk of getting the test in the first place. We have moved into a different realm of “educated guesses”.

Today, having converted most of today’s patients from in-person office visits to video visits, I take a moment to sit back and wonder where we would be without our current technology. While we have all to some degree or another chastised our obsessions with smart phones, without the capability for messaging, we would be forced to bring our most vulnerable patients out into the world for possible exposure to hostile pathogens. What did we do before we had this level of technology?

I remember when our children were small, my in-laws lived in Texas (we are in Indiana) and my parents were in Tennessee. We tried some new technology (for the mid-1990’s) that included a video camera, a computer running a 486 processor, and a dial-up internet connection. We talked over each other and watched the fragmented video blips much like when we watched the moon landing in the 1960’s. Oh, how far we’ve come. Now, with FaceTime and Nixplay, parents, grandparents, great-grandparents and children can all get on the same call and interact visually as well as audibly. Hearing those first coos of your first grandchild are amazing and even better when you can be there virtually.

Now that everyone has an iPhone or an Android, using FaceTime, Facebook Messenger, Skype, Google Hangouts, or Zoom connects us in ways we never dreamed possible. We all connect in (almost) real time, watching our family and friends as we chat with them. We use the technology to stay in touch and can see facial expressions as they respond to our discussions and even our worst “dad” jokes. We can isolate, yet still be connected. We can put together the senses of sound and sight.

While I am always thankful for the my faith, family, friends, and freedom, I am especially thankful for our technology. Without it, I would need to take drastic steps- like, opening a book.