Before COVID-19, Zoom and similar devices, telephone landlines, iPhones, the U.S. Postal Service, and FedEx were supplements to person-to-person communication. Today, in the conflagration of COVID-19, these services—particularly services such as Zoom, Skype and others—have replaced group meetings, professional and family, as well as the camaraderie of having a drink and meal together, traveling and sightseeing. What will happen after the COVID-19 pandemic?
We recognize that our lives will be changed forever. The social and communication impacts have already become the everyday conduct of business, private lives and health care. The implications of voice and image services, combined in the future with holography, will be as transformative as the introduction of electricity, the automobile and the airplane.
My father, a wise man, taught me that with any major world upheaval there are losers and winners. With the advent of the automobile, carriage makers lost their livelihood and car manufacturers gained theirs. Who will be the losers and winners after COVID-19? What will happen in commerce, the hospitality industry and entertainment? Will planes fly less often and aviation fuel stocks plummet? Will all those cruise ships, large and small, stand idle or sail half-empty? Will movie theaters fold and live theater diminish? Will there perhaps be a biphasic response? When COVID-19 is eliminated by vaccines and eventually herd immunity, we can expect that people will leave sheltered environments and shed face masks and social distancing. At that time, they may seek crowded venues and the freedom of travel, filling restaurants and bars to legal capacity.
What will be the outcome of the pandemic innovations and restrictions on our professional lives? I believe some reasonable predictions can be made based on current data and trends in considering the transformations—present and potential—in the doctor–patient relationship, continuing medical education and professional meetings, and health care in general.
Doctor–Patient Relationship
The doctor sitting at the home bedside of a sick patient disappeared long ago. Virtual patient visits were becoming a reality prior to COVID-19. During COVID-19, they became the norm. A virtual visit cannot include a hands-on physical examination; however, the physical exam has been superseded by laboratory tests and radiography. Even here the necessity of coming to a laboratory for tests has, for certain assessments, been replaced by home test kits and devices. One could argue that, at least for surgery, there needs to be a physical relationship between the surgeon and patient. Not necessarily: Robotic surgery can be performed with the operating surgeon miles, even continents, away. The first documented robot-assisted surgical procedure was performed in 1985 in a nonlaparoscopic neurosurgical biopsy operation; the first robotic cholecystectomy was performed in Belgium in 1997; and in 2001, a trans-Atlantic cholecystectomy was performed by Dr. Michel Gagner in New York with the patient in Strasbourg, France, under the supervision of Dr. Jacques Marescaux.
We have embraced the virtual world, and in doing so, we are obligated to make it work not only for us but for our patients. Long-range robotic surgery can bring skills and technology to people and places deprived of these benefits. Virtual doctor–patient visits can enhance frequency of communication and, by their availability, actually rekindle the intimacy of patient care. By eliminating the need for a dedicated clinical space and the personnel to run it, virtual patient visits may be cost-effective.
At the same time, we, as the providers of patient care, must be vigilant in this virtual age, cognizant of how technology can negate the personal bond of trust inherent in the doctor–patient relationship. Empowering administration to set the time allotted for a patient visit implies tacit approval by physicians for administration to regulate the spacing of patient visits, the exchange of patient care physicians, the utilization of service lines and eventually even extending impersonality by substituting surgeons during an operation dependent on OR time spent. Steps such as these, made one at a time, lead toward our profession becoming, in effect, part of a business firm run by CEOs, with surgeons as employees performing a service and patients representing paying clients. Taking personal responsibility for the doctor–patient relationship, its performance and outcomes, in and out of the OR, has always been the cardinal ethos of surgery. Let us not be maneuvered into negating that heritage of trust.
Continuing Education
Every day I receive an email with an offer to view a video or join a Zoom presentation on timely topics of medical/surgical therapy, including COVID-19. Most offers are free; some require a registration fee. Some offer CME credit, whereas others do not. This barrage of information has increased a thousandfold since virtual communication became a necessity. Will it continue after COVID-19? Although many of these offers are not useful or appealing, some present opportunities for self-selected continuing medical education (CME) made conveniently available. Will this trend further decrease subscriptions to peer-reviewed journals? Perhaps. As stated, with every major societal upheaval, there are losers and winners.
An integral aspect of our professional lives, especially for those of us in academia, has been attending the regional, national and international meetings of the societies to which we subscribe. These occasions provide continuing education, but they are also occasions for camaraderie, for seeing friends, eating out, sightseeing and, quite often, person-to-person discussions in hallways or over coffee or a drink on job opportunities, changes in locale, and for ongoing research and innovation. In the past, those occasions for learning were combined with pleasure involving travel, the need for accommodations and other expenses, which have been partly or wholly reimbursed as business or academic travel, as well as tax write-offs.
COVID-19 changed all that. Meetings were canceled, deferred or held virtually. A virtual meeting offers continuing education but not the personal moments of being in the same room with colleagues. Virtual meeting attendees are deprived of the free give-and-take after an in-person presentation and the discussion possible in a meet-the-expert session. These meetings do not offer the varied pleasures of travel, or of being accompanied by family and friends.
The advantages of virtual meetings are many, however—advantages that may well carry over to the post–COVID-19 era, including increased registration, especially from overseas, enhancing the primary objective of continuing education with a wider dissemination of knowledge. With the elimination of travel expenses, virtual meetings will allow entire medical departments, practice partnerships and hospital divisions the ability to attend a distant meeting. For the same reason, more people could register and attend more meetings than they ordinarily might have. By streaming, attendees could select the time to watch a session, for example, a time not in competition with the OR. And, the organizing society can collect registration fees from a larger group of attendees without the expense of renting meeting venues, paying for staffing and staff travel.
I am certain that meeting exhibitors were at first distressed by virtual meetings that deprived them of the opportunity for product display booths. On the other hand, company leadership probably welcomed the huge reduction of expenses for rental of space, etc. At a lesser expense, exhibitors were able to advertise on the virtual meeting broadcasts, comparable to their current ads on commercial TV.
Future scientific meetings may well be hybrid affairs. It is difficult to imagine the advantage of a greater dissemination of knowledge at a lesser cost being discarded in the world beyond COVID-19. At the same time, hands-on, same-site presence will continue to be essential for certain professional learning and transactions. In addition, the human social instinct will find plausible reasons for coming together for personal contacts. The lure of travel will also provide an impetus for justifying live meetings. Thus, the solution may, in fact, be hybrid affairs: certain groups meeting in person, others by virtual and streaming presentations and discussions. While offering less personal enjoyment, virtual hybrid professional meetings may offer a greater opportunity for continuing education at a lower cost.
Health Care
Proof of the decline of U.S. health care is evident in hard global statistics. In essentially every measure of excellence we are not world leaders, not even close. We markedly trail other nations in life expectancy, mortality rate, years of potential life lost, disease-specific mortality, infant mortality and the availability of health care. We are, however, indisputably world leaders in the cost of health care.
As illustrated, there are certain dangers for medical practitioners and our patients in the virtual world post–COVID-19. With respect to national health care, however, I am more optimistic. Advanced technology made available to health care has been uniformly advantageous: The stethoscope was an improvement over an ear to the chest; x-rays were more convincing than palpation; radiation could ameliorate cancers; rapid transport enhanced availability of care in war and in peace; and instant communications have increased the dissemination of knowledge and expertise. The technology imposed by COVID-19, therefore, may help our nation take the path to remedy our health care statistics.
Dr. Buchwald is a professor of surgery and biomedical engineering, and the Owen H. and Sarah Davidson Wangensteen Chair in Experimental Surgery (emeritus), at the University of Minnesota, in Minneapolis. His articles appear every other month.
This article is from the February 2021 print issue.
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