How can we manage covid fatigue?

Dear Editor,

I hope that you are in the best of health and staying safe! While I do agree with many points in your article, I must admit that the rather dreary outlook, though a realistic one, is not necessarily a complete depiction of how we have been adjusting to the overstaying visitor that SARS-CoV2 has become.

As we traipse further along the turbulent tracks of the COVID-19 pandemic, entering a spring-time scene of cautious optimism, we see many changes that once seemed temporary beginning to enter a more everlasting part of our daily existence. We’ve seen the normalization of online events, meetings, and education; the rise of vaccine acceptance and a shift in the delivery of healthcare. With this in mind, we look to the meteoric rise and acceptance of telemedicine.

Telemedicine is ‘the use of technology (computers, video, phone, messaging) by a medical professional to diagnose and treat patients in a remote location.’ [1] Though not a new concept, a survey by the Royal College of GPs found that six in 10 appointments in mid-July [2020] were conducted by telephone. [2]

As we see telemedicine becoming the norm, with clinic days in a general hospital setting being mostly via phone or online, we see the success of technology aiding us in the face of adversity. There are many advantages to this. Firstly, it is convenient. Patients can discuss their condition and follow up with their health care providers from the comfort of their homes. Through this we also see an improvement in the access to healthcare as well as increased adherence and attendance to scheduled appointments. Furthermore, it is cost effective. Patients spend less time and money reaching to and being in the hospital itself. [3] When Covid-19 hit, we (doctors) were instructed to discourage patients from entering the practice physically in order to keep them and the staff safe. [2] Keeping this in mind, there is less exposure to illness and infections for both the patient and the healthcare provider with telemedicine. [3]

There are, however, some downsides to this. Whilst technology is constantly making gargantuan strides that we are evolving and adapting to daily, it is sometimes easy to forget that not everyone can use technology or may have difficulties in doing so, particularly older patients. While the accessibility is increased for doctor-patient interaction and flow, this may not apply to all age groups. Through this, we also see the aspect of physical examination removed from an average consultation and doctors must rely on self-reporting from the patient. [3] Ethically, a patient has autonomy over how they are treated, and the decisions made for them (assuming that they are compos mentis and taking their respective situation into consideration). But what happens when there is incongruity between what the patient is describing to their doctor and what the patient’s actual diagnosis is. Long-term COVID is an uncharted territory for all healthcare workers, with idiosyncrasies that range a multitude of systems and symptoms. And while every doctor makes a vow to do no harm, what precautions can be taken when a condition is to be treated without a face-to-face interaction, inappropriate description or ignorance due to sheer lack of knowledge.

As telemedicine becomes more commonplace, as with any technological advancement that is accessible that also affects the general population, we also see the introduction of guidance and guidelines coming into play. Guides, such as the ones that are available on the Irish Medical Council’s website, contain information and practical advice for doctors who now utilise telemedicine systems for a large proportion of consultations. [4] It would not be unwise to assume that workshops for effective telemedicine communication could soon be introduced, and even introduced into medical curricula.

The field of healthcare is a periscope in which we are privileged to see inside the lives of the people around us. We see that their condition doesn’t define them but is only a fragment of their multifaceted life. But when a patient becomes a mere voice on the phone, with a complaint or condition, it shows us that we are often limited as doctors in improving the patient holistically rather than just trying to alleviate their ailments. And with COVID, we've seen these deficits highlighted. Through lack of inappropriate management, lack of efficiency in implementing regulations, and the ever-increasing burden on healthcare workers and patients. To quote Plato, if 'necessity is the mother of invention,' whilst technology has greatly aided us to overcome some of the physical barriers that the pandemic has presented, one must wonder, at what cost?

Which is why, dear editor, whilst I completely agree with your statement on how 'the pressure on healthcare systems and staff is causing moral distress and injury', with overworked, underpaid and under-appreciated employees moving away from healthcare, perhaps, as we move towards our inevitable freedom, we can take a fraction of solace in the medical advancements we've made during these tumultuous times. With vaccinations and voracious adaptations to the whims of a virus that cannot be viewed, perhaps one day we can look back on this era of healthcare with valediction.

References:

1. Chiron Health, (2021). What is Telemedicine?.
2. Stokel-Walker C.. Why telemedicine is here to stay. BMJ 2020;371:m3603(): doi: https://doi.org/10.1136/bmj.m3603 (accessed ).
3. Medical News Today, (2020.) Telemedicine benefits: For patients and professionals. https://www.medicalnewstoday.com/articles/telemedicine-benefits (accessed ).
4. The Medical Independent, (2020.) Medical Council releases new telemedicine guide for doctors. Available at : https://www.medicalindependent.ie/medical-council-releases-new-telemedic... Medical Independent.