I’m a virtual doctor and I’m making things up as I go along

Last night I dreamt I was #Santa.

As dreams go, I suppose this is a reasonable facsimile of my real-life #job. I’m a #familydoctor. I see patients one by one, ask them questions, and listen carefully as they explain what kind of health they wish for. It’s not completely different from playing Santa in a shopping mall.

Especially lately. Parts of my regular job have been shut down by COVID-19, so I work for Ontario’s new Virtual Care Clinic for a few shifts each week.

Patients can log in to the #virtual care platform, wait for a few minutes, and then talk to me over their #computer or #phone #video #cameras. It’s instant #medicine. It’s probably easier than going to a mall to see Santa, especially these days.

In summer, there were a lot of people calling from Ontario’s cottage country. They were away from their own doctors in the city, and now they wanted someone to look at the rash their child had. Was it a tick bite? Did it require antibiotics to prevent Lyme disease? I saw a handful of these mosquito-or-tick bites every summer shift.

Lately it’s been pinworms. Families can’t get an appointment with their own doctor, and they need pinworm treatment for the whole household.

“How big is that worm you saw?” I ask them. I draw a squiggly line with a pen on paper and hold it up to the camera. “Does it look like this?”

I now regularly ask patients to be their own examiner.

“Is that rash warm when you touch it, compared to your skin on the other side?”

“If you push your fingers into your own abdomen slowly, then let go quickly, which is more painful – the pushing or the letting go?”

“Hold that elbow up to the camera for me. Now show me how much you can bend it.”

This is cowboy territory. I am making this virtual medicine up as I go along.

I regularly tell my virtual patients all of this. “I would be more confident if I could see you in person,” I say to the person whom I suspect has a bladder infection, or pink eye, or gastroenteritis. “We can flip it around and treat you first, but in normal times the #physicalexamination would come before the #medicine.”

I give them the choice. Everyone chooses treatment first. Everyone is online because they have already chosen. They don’t want to see a doctor in person. They don’t want to catch #COVID19. They don’t want to wait, or drive into town.

Sometimes I tell them to see a #doctor in real life, anyway.

There was a family who called in because their elderly relative had fallen. He had been lying in bed for several days, complaining of leg pain, getting weak, refusing to get up. It hurt too much.

I asked his son to pan the camera along the length of his father’s legs. Sure enough, the injured side was shorter and rotated outward. There was a good chance he’d broken his hip. He needed an X-ray, and probably surgery.

“What else can we do?” asked his son. “I want to do this online.”

I thought about it. Was there any way, at all, that I could heal a broken hip online?

“I can do nothing,” I told him, frankly. “Online, I can do nothing.”

On reflection, it wasn’t quite true. After all, I then spent quite a bit of time talking to the family. I explained why it was important to fix a broken hip, and what would happen if they didn’t. I talked about infection control in #hospitals, and why they are safe. We talked about how to get their father comfortably down the steps at the front door.

In the end, they agreed to take their father to #hospital.

I’m surprised how many people I’ve persuaded to go and get real-life, in-person medical care this year. That’s become my expertise. Your crushing chest pain could be a heart attack. That pain with breathing needs an X-ray. Let me tell you why you need to be seen and examined. Let me tell you why it’s safe to go.

As #Christmas draws near, I realize I can do about as much as a shopping mall Santa. I can ask questions and listen carefully to your answers. I can promise a future where your wishes come true. I can give you a lollipop or two. But ultimately, I will hand you back to your parents to make the real magic happen.




Sophie Wilson is a family physician based in Waterloo, Ont.

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