Telehealth Fatigue

My patients are loving telehealth. They love it so much that most of them are saying they don’t want to come back to face to face consultations. You probably need to bear in mind that my patients are long-term therapy patients that I know very well.

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We are already comfortable in each other’s presence and can read each other’s non-verbal cues without being in the same room or for that matter, within eyeshot. That makes it easier on both sides. Seeing new people is another rung up the ladder in terms of demands on the practitioner. For most practitioners it seems a day of telehealth consultations is much more demanding and tiring than a day of face to face consultations. What’s that about?

  1. It’s more sedentary

In my office, when I’m seeing people face to face, I get up at least once an hour. I get up to make a cup of coffee, move to the desk to write up the notes, go downstairs to go to the toilet or check the mail and go to the waiting room to call in my next patient. At my computer I just make another call, still sitting in the same spot and staying there all day, with only an occasional comfort stop when I finally remember it’s needed.

 I need to make a conscious effort to get up and move around at regular intervals or by the end of the day I’m lucky to be able to get out of the chair at all! Low levels of physical activity can be very tiring.

  1. It requires more concentration

OK, so I blithely say things are easy for me because I know all my patients well, but the truth is that working on a video platform or on the phone without video really does take more concentration. Phone calls mean listening harder to read vocal cues. Lack of facial expression means concentrating on being very clear and unambiguous about what I am saying and making sure I explain myself if ambiguity is lurking. Lack of my patient’s facial expression and body language means its harder to catch any discomfort or misunderstanding that might be occurring.  Even video calls, where only heads and shoulders are visible, can hide potentially important body language from sight. All that intensity can really take it out of you.

  1. It’s more anxiety provoking

We are all different but, because it’s difficult to be certain about whether communication is clear in non-face to face situations, it’s easy to become more anxious about the content of a consultation. I’ve found new strategies are required to ensure that the message intended is the message received, (in both directions) and these take time to develop, time to implement and are often different for each person I see. More effort, more fatigue and slipping into worry about the content of a consultation is all too easy.

4.The technology can make it harder

If you’re using a video platform, whilst you have an advantage of seeing the person you are talking to and their seeing you, there are sometimes technical aspects of its use that can get in the way. This certainly applies to family and relationship work and team care meetings especially if people are coming in from more than one location or device. Technical distractions can make concentration and communication more difficult and more taxing.

Personally, I struggle with a poor internet connection at home and I’m on tenterhooks most of the time in case my connection becomes is interrupted. It’s a stressor I could do without. Other distractions include email notifications and other popups – not just for me but also for the people I am talking to.

  1. My eyes get sore!

We know that one of the most important parts of non-verbal communication in most cultures is appropriate eye contact. That means looking at the screen, specifically at the camera, a lot! To make this work your camera needs to be somewhere that you can look at it and see the person you are talking to at the same time. Ocular gymnastics are required!

Sometimes, at the end of a day of back to back screen time, I find I don’t just have sore eyes I also have blurred vison. There have been days when I haven’t been able to see well enough to drive. Luckily, that usually happens when I have spent a day looking at the screen at home so no driving is required, but on days like that I’m left with the feeling that all I want to do is lie down and close my eyes.

All of that leaves me back on the telephone with people taking my calls from all sorts of places: their lounge rooms, while walking the dog in the park, from the car while parked or even while driving (it’s oK, I won’t let them do that!).  This can leave them distracted and me depending on vocal cues only. So even without the video-related aspects I’m still experiencing telehealth fatigue. 

I’m not denying there are a lot of advantages in telehealth for many people and I do hope it continues under Medicare.  I think it’s wonderful for everyone to be able to access the care they need despite geographical disadvantage and public health restrictions but I am, saying it is not as easy as one might think.

So what’s the upside of telehealth for me as a practitioner?

First, there’s the knowledge that I’m doing a job that’s needed.

Then, there’s the fact that without the demands of dressing for work and travelling to the office I can fit more consultations in my day. But, then, maybe that’s not such a good thing either?

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Dr Jan Orman

Jan is Sydney GP, private psychological medicine practitioner in Sydney’s inner west and a GP educator for Black Dog Institute.

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