For Dr. Sharon Smile, Zoom medicine lacks the human touch: 'There's a bit of a disconnect'
By Louise Kinross
Dr. Sharon Smile used to share an autism diagnosis with a family in person at Holland Bloorview. Now, thanks to COVID-19, that conversation happens online, with the family receiving the news in front of a computer screen in their home.
Earlier this month, Dr. Smile, who is a developmental pediatrician, wrote a blog post in the Canadian Medical Association Journal about the challenges of virtual health-care for parents and clinicians alike. “I have sometimes left the Zoom meeting by clicking the “End Meeting for All” button with a persistent draining feeling of inadequacy,” she wrote.
That's because while the process of conveying a diagnosis is the same, “what is lacking is human contact,” Dr. Smile says. “Before we were at the hospital together physically, and being present allowed me to support them physically and emotionally. Now we're entering a family's home, which can be viewed as a sacred and safe place. There's a bit of a disconnect. One parent described it to me as traumatic: 'You brought trauma to my house.'”
While some families welcome the new knowledge about their child, others “are terrified, frozen, silenced, helpless, crying and gutted,” Dr. Smile wrote in her CMAJ article.
When sharing a diagnosis in person, Dr. Smile would sometimes have an opportunity to leave the room to give parents time and space to reflect, before coming back to continue the conversation. “When supporting them virtually, you can't do that,” she says. “You can turn the screen off or mute the microphone, but the family is still in their own space dealing with what has occurred. They're kind of trapped.”
Sharon says she was feeling a “constant distress,” because she felt she was missing something in supporting families. She reviewed best practices in telemedicine and delivering diagnoses, thinking she perhaps had to alter her method.
But then she had a revelation. “The gap was not in the information disclosed or my method of disclosure,” she says. Instead, it was related to two things.
First, “the missing piece was that human contact and human bond. It's easier to build trust or a bond with a family in person, and to see the signs that a family may be at higher risk for crisis, or need more support.”
Dr. Smile says she wrote her CMAJ piece to help other clinicians understand that “you'll go through different emotions when working virtually. You know empathy and compassion are key to what you do, and you keep asking yourself: 'How can I support this family the same way I did when I saw them in person?' No matter how much we try to be animated and mindful of parents' experiences, there is a disconnect virtually. It can cause a sense of 'empathy fatigue,' where you leave an appointment with a bit of distress because you feel like you haven't completed your task.” Rather than viewing that distress as a sign of inadequacy, see it as a sign of humanity, Dr. Smile says. “It's okay to be human.”
Dr. Smile's second learning was that she needed to move away from a “breaking bad news” framework to one that conveyed autism as an assets-based disorder. “We need to shift our language. Words matter. By presenting a child's strengths first, parents can see the beauty in their child, and their skills and gifts. Then we can talk about the struggles or challenges and how we can match a child with the right resources to foster those skills. Framing autism as strengths-based and looking at the positive things can help the family move forward in their journey of acceptance and accessing services.”
Dr. Smile says the virtual platform creates new emotional needs for families and clinicians. “I try to understand how the parent will be feeling when I'm giving this disclosure, and recognize, based on my understanding and meeting with the family, what immediate supports they have in place. We have to be mindful of the increased potential that parents are socially isolated during COVID-19. If this is a single mom with no social network, what supports do I need to put in place? I will connect her with a social worker and reach out two weeks later myself to check in.”
Clinicians also need to build in their own self-care. “When giving a diagnosis in the hospital, you can stop by and talk to the social worker afterwards, or individuals may have their own ways of debriefing with colleagues and asking 'Are you okay?'” she says. “When we went to virtual care, that way of taking care of our emotional health wasn't built in.”
Dr. Smile says virtual, family-centred care and physician wellness don't need to be mutually exclusive. If she's doing a Zoom assessment with another clinician, it's important to debrief afterwards about how to best support the family, but also to check in on each other's emotional needs.
She also recommends these wellness resources for clinicians:
Headspace has meditations, mindfulness and stress-relief practices for health-care professionals.
The Ontario Medical Association Physician Wellness Program has coping strategies for dealing with stress, mindfulness exercises and a confidential help line. This article on physician self-care is helpful.