Making a Connection

I am thrilled to welcome Dr. Todd Stern to Sensible Medicine. Todd and I have worked together for years. He had the office next to me when I arrived at The University of Chicago in 1997. At the end of each day, I would run the decisions I had made by him, and he would tell which sounded good and which I might want to reconsider. He has supported me with not only deep knowledge of medicine but with the humor he brings to the occasional drudgery of our work.

Adam Cifu

Ms. Hampton, age 71, is scheduled for a twenty minute 8:30 am primary care video appointment on a morning when I am working from home. It has been increasingly more difficult for her to leave her apartment. I haven't seen her for months.

8:25 am: After receiving a desktop alert for the visit, I log into the EHR and briefly review her record.

8:29 am: I open the video conferencing software and look at myself.

My hair is bad today.

The touch up doesn't help much.

I wonder if this T shirt is ok.

I am wearing shorts.

Would I look better reversed?

The room is a mess.

Maybe I should change the background. I settle on blurring.

8:34 am: Ms. Hampton hasn't entered the meeting yet. I had better call. Because she might be using her mobile phone to join, I choose her non-cell number. I call with my number blocked and she blocks me. I call her cell. Blocked again.

8:37 am: I call with my phone number unblocked and finally she answers. Now she has my cell number. Her daughter Martha is there to help. Ms. Hampton hands her the phone.

Note to self: Sign up for phone service through a physician social network and overcome my reluctance to be deluged with updates or entreaties from every person who ever had any association with my college, medical school or hospitals.

8:38 am: I introduce myself to Martha and ask her to help her mother open the patient portal to the EHR on her laptop. They access the account, but the video link is "grayed out."

If I had time to contact my hospital IT, they would send an email with the job number and my place in a queue.

8:40 am: I ask Martha to give the phone back to her mother so that I can get her email address. I copy the link from the video meeting invitation, paste it into an email message and click send. While I am doing this, we exchange pleasantries.

I know that I am not supposed to send a link to the video via insecure email, although I doubt that the Russians are going to hack into the visit. I am less certain about the DOGE.

If my hospital IT were aware of what transpired, it would send another email informing me that they were working on it.

8:41 am: While I’m waiting for her to receive my email, our cat jumps on the keyboard. I have to reboot.

8:46 am: Back online, but the email hasn’t arrived yet. I am considering converting the interaction to a telephone visit. I take the opportunity to ask Ms. Hampton how she is doing. She is fine except for low back pain.

8:48 am: No email yet. I suggest that she click on Send/Receive. I keep checking the screen.

8:49 am: The email link works! Ms. Hampton's name comes up on the screen, then I see her face and a limited view of her home. It’s a virtual house call, a window to her world. I wish that I could see more.

If hospital IT were involved, they would send an email informing me that the problem was resolved.

Unfortunately, there is no sound. We are still on the phone. I ask Martha to try a few things that that might work:

Unmute the laptop.

Unmute the video software. On my screen the mute button is in the left lower corner of the window.

Try the video link on the cell phone. Choose call over internet.

I check to see that I am not muted (gulp).

8:50 am: The email link works--video and audio! Ms. Hampton’s chronic low back pain is worse, but there are no alarm features. She reviews the long course of her condition. We are both frustrated. I review safe non-prescription analgesics and offer physical therapy.

I look at her while she is speaking. We are watching each other, but can’t make eye contact. Depersonalized, the video interaction promises more than it can deliver.

I minimize the video and move the window to the right upper corner of my monitor. Still listening, but now focusing on the EHR, I finish my note and change the billing time from 25 to 40 minutes.

9:05 am: I offer to refill her medications and suggest that she make an in-person visit later in the year.

The cat is on the desk near the keyboard.

If I had contacted hospital IT, they would send an email asking me if I needed anything else.

10:30 am: My phone is buzzing. It’s Ms. Hampton.

Todd Stern MD is a general internist at the University of Chicago.

Photo Credit: Catherine Heath