Francis V. Adams, M.D.
I am looking across my desk at an empty client chair while I await the start of my next virtual office visit. The new world of Covid-19 has ushered in telemedicine literally overnight and I am still learning and adjusting to medicine via video feed. I look longingly at my stethoscope, which sits next to two antique scopes (adult and pediatric) that I keep on my desk. They are more than 100 years old and resemble the original invention designed by Rene Laennec in 1816. The scopes are conversation starters that I incorporate in discussions about advances in medicine. The electronic stethoscope that hangs around my neck, which can amplify, record, and broadcast, astounds most of my listeners as they glaze at the two wooden instruments.
I have an affinity for breath sounds. I know that I was gifted with excellent hearing as audiometry has demonstrated more than once. Childhood tuberculosis stimulated my curiosity about the lung, and I am sure contributed to my decision to become a pulmonologist. I’ve enjoyed researching and lecturing on breath sounds and teaching auscultation to medical students as they learn physical diagnosis.
Long before there was much science to medicine there was the “laying on of hands”, a way of healing all type of ailments, simply from the touch of another human being. The physical exam, where the doctor feels and probes but also listens is a direct extension of this phenomenon.
Covid-19 has made telemedicine necessary but I fear that it will indelibly change the landscape of medicine. The benefits are clear – patients tell me daily that the virtual visit reassures them that I am “still there” – available if their health fails. I can listen to their complaints; advise, and even prescribe based on what they relate. A modified “exam” can be done where I ask the patient to turn the camera at a certain body part or walk around the room or blow out into the microphone of their phone to see if they are wheezing. I can observe their breathing patterns, look for edema and cyanosis. I can look but not touch.
I suspect that when it is safe for mankind to emerge again, a significant percentage of my patients will elect virtual visits over a physical one. Patients with arthritis or difficulty breathing who labor to walk will choose to visit from the comfort of their home. Healthy individuals with mild asthma who come to the office primarily for a refill of their rescue inhaler will also favor the ease of a virtual visit. The residual fear of transmission of infection, whether from the coronavirus or another pathogen, will also prompt a number of patients to choose virtual over physical.
What will become of my stethoscope? I believe it will further evolve through technology with the development of an electronic scope designed just for remote video examinations. It might even look like the antique instruments that sit on my desk.
I see myself saying to my patient, “Please place the open end of the e-scope against your upper right chest, take a deep breath in and let the air out slowly.” Dr. Laennec would be proud.
Francis V. Adams, M.D. is a pulmonologist at NYU Langone Health and an Associate Professor of Clinical Medicine at NYU. He hosts Doctor Radio on SiriusXM 110 weekly.