Today, I met a patient I have known for many years. He suddenly took off his mask and said, “I want to know what you think I should do.”
There is an 8 mm (1/3 inch) brown-red flat spot on his nose with a crack or scratch.
“How long have you been eating?” I asked.
“Oh, it’s been a while,” he replied. This is the least helpful time measurement I know. I asked him to write it more accurately. He settled down for about a year. I prescribed a cream and made an appointment for two weeks of freezing or biopsy follow-up. This may just be a reprimanded, pre-malignant, actinic keratosis.
Back when life is different, this will not be ignored. But, of course, we have been wearing masks for more than a year and a half. No wonder I just talked to that person without noticing.
I walked across the hall and told my new partner what had just happened.
“Oh yes,” she said. “The same thing happened to me-a type of basal cell carcinoma. I find it sometimes difficult to assess the emotional state without facial expressions. And, to make matters worse, I have a lot of new patients, I don’t even know What do they look like.”
“Of course, you started six months before the pandemic”, I signed up. “That must feel strange.”
Telemedicine is considered better than telemedicine because you can visually judge behavior, facial expressions, and many other things better than hearing alone. So, what scope does masked face-to-face interview fall into? Of course, we can see shaking heads and shrugs, so a masked interview is better than a phone interview, but my next thought is that maybe I should reconsider my doubts about a former colleague I heard about the other day.
The doctor will now have a patient sit in the examination room, and she will sit in her office. In front of the patient is a computer, and the two of them are basically doing the first part of the interview, as if they had a “routine” telemedicine consultation. Then, the doctor may or may not enter the office in order to perform any medical examinations necessary for the clinical situation.
I suddenly saw at least a little bit of logic in this method. Because then they can both speak without a mask. (Or you should, based on what we now know about aerosol transmission in the examination room and all…).
Hans Duvefelt is a Swedish-born family doctor in rural Maine. This article originally appeared on his blog, and the village doctor wrote, here.