CMDA's The Point

Virtual Doctoring, Virtual Church, Virtual Life

July 23, 2020

by Amy Givler, MD

When this pandemic started, I, at least, had heard of Zoom. My husband Don, also a family physician, had no clue. We’re both in our 60s and feel simultaneously confused and outdated whenever a new form of technology emerges. Picture a donkey leaning back on the rope held by someone trying to drag it forward. You get the idea.

When in a pinch, however, we are capable of learning. And COVID-19, if it is anything, is certainly a pinch. Within a week of Louisiana’s lockdown in mid-March, we were watching our church online, and within two weeks Don was leading Sunday School via Zoom. In fact, the first Zoom meeting he ever attended was one he led.

Two months later, Louisiana again allowed in-person church with reduced capacity, but I didn’t return. Being a physician puts me at higher risk of infection, and our church has many older adults. I didn’t want to unknowingly infect them if I was pre-symptomatic. Happily, they continue to live stream the service, so I have maintained a sense of connection. But I miss my church family—the people. I miss the gathering, the greeting, the hugging, the sitting next to people who are also focused on connecting with God.

In my outpatient clinics during March, I saw few patients. We didn’t have telemedicine set up yet and, knowing so little about the virus and wanting people to stay home, I postponed all but the most urgent in-person visits. It wasn’t until early April that I saw my first patient virtually.

That woman, my patient for numerous years, has a difficult home situation. I was eager to find out how she was handling the home confinement. It had taken 30 minutes to set up the visit, with most of that preparation done by my nurse, but I had also spoken with her on the phone trying to get the technology to work. When we were finally looking at each other through our respective screens, I asked her how she was doing. She responded by bursting into tears.

We spent the next 20 minutes talking about the struggles of being home, and then we discussed her health and medications. Being able to see her definitely felt more substantial than a phone call, but, I realized as we said goodbye, something was also missing. Had we really connected?

In 1994, Sven Birkerts published The Gutenberg Elegies: The Fate of Reading in an Electronic Age, in which he reflected on the impact of email, e-books and screens in general, which was the infancy of the internet in 1994. Though phones were not “smart,” he saw that even this technology had changed human interaction: “At earlier stages of history, before the advent of the sense-extending technologies, human interactions were necessarily carried out face to face, presence to presence. Before the telephone and the megaphone, the farthest a voice could carry was the distance of a shout.”

What does it take to say that we “know” another person? Is presence necessary? Birkerts asks it this way: “Do we each, as individuals, have an aura, a unique presence that is only manifest on site, in our immediate space-time location? And if we do, how is this aura affected by our myriad communications media, all of which play havoc with our space-time orientation?”

Now that I have conducted dozens of telemedicine visits, I think “aura” is a good way to describe the elusive thing I’ve been missing. I would have never thought of the word “aura,” but, hey, it works. As a physician, I want to truly connect with my patients. Happily, my telemedicine visits have only been with established patients thus far. I wonder whether any kind of connection will be possible with someone I’ve never before seen face-to-face.

We are relational humans. Seeing and talking to a person through a screen is better than nothing, but it’s not fully adequate.

One thing missing in telemedicine is touch. In a face-to-face visit, I always touch my patients—sometimes only during the physical exam, but usually other times also. A comforting hand on a distressed patient’s arm can be therapeutic.

In a misguided overemphasis on hygiene, therapeutic touch was undervalued for the first 40 years of the 20th century. Institutionalized children, in both hospitals and orphanages, suffered terribly from their caretakers’ fear of germs. Before Henry Dwight Chapin spearheaded foster care as an alternative, infants in orphanages died nearly 100 percent of the time. Hospitalized babies, whose nurses were discouraged from touching them, and whose parents were barred from the hospital, became listless and fed poorly.

In a groundbreaking medical article from 1942, “Loneliness in Infants,” Dr. Harry Bakwin urged his readers to touch their young patients. He included several photo pairs: the first of crying, emaciated babies on the day of discharge from the hospital, and the second of a plump and happy baby some months later, after being cared for at home.

“It is not surprising … that the young infant should suffer when deprived of the warmth and security which he derives from contact with the mother or a substitute. Nor is it to be wondered at that the younger the infant the more important is this contact. The young infant is dependent on the environment for gratification of his psychologic needs just as he is for satisfaction of his nutritional needs. Only during the later months of the first year does he acquire a certain degree of independence. And just as the young infant has relatively few nutritional reserves within himself to fall back on during a period of starvation, so he has little in the way of psychologic resources to use when he is deprived of gratification of his psychologic requirements. The infant lacks the mental equipment which permits the adult or even the older child to tide over periods of loneliness by day-dreaming and planning for the future. In this respect, as in many others, he resembles the aged person, for whom also loneliness may be fatal.”

I know for many doctors, telemedicine is nothing new. Likewise, many people have been doing “virtual church” for decades. Since the 1970s I’ve heard of people watching television church services, considering that their “church.” Live streaming church in the middle of a pandemic is one thing. But never physically attending, even when the risk to health is low, is quite another.

As pastor Brian Zahnd wrote, “…let’s not normalize what is a move away from what it means to be human. Virtual church is like a virtual beach vacation – it’s just not the same thing. A beach vacation means sand between your toes, and real church means sacrament and human contact.”

Both electronic church and telemedicine have served us well, as a society, during these months when face-to-face contact is risky. But should these things become the norm? I say no.

We are relational beings created by a relational God. We are enfleshed bodies, and we are social creatures to our core. We desire to be known and to be appreciated in all of our fleshy humanness.

We need, that is, not only to be “in touch,” but to be touched.

Amy Givler, MD

About Amy Givler, MD

Amy Givler is a family physician in Monroe, Louisiana. She and her husband Don met in 1980 at a CMDA student event her first year of medical school, and they have both been active members of CMDA ever since. Amy graduated from Wellesley College and Georgetown University School of Medicine, and she then completed her family medicine residency at the same indigent-care hospital where she now works part time. She also works at an urgent-care clinic and is the medical director for a Shots for Tots clinic. Amy loves to write and has written many articles and one book, Hope in the Face of Cancer: A Survival Guide for the Journey You Did Not Choose. She and Don have a heart for missions, and hope to do more short-term trips now that their three children have launched from the nest.

1 Comment

  1. Avatar Barb Okamoto on August 5, 2020 at 9:00 am

    Thanks Amy! I totally agree. There is definitely a joy if fellowship that is missed in the virtual realm and the human touch is irreplaceable.

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