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COVID's Telemedicine Boom Reorders Doctor-Patient Dynamic

France is just one of many countries that have long shunned online consultations. But now that it's skyrocketing in pandemic times, there may be a mini revolution in health care.

A whole new game
A whole new game
Marie-Joëlle Gros

PARIS — From patients' bedrooms, sometimes directly in their beds. In the car, pulled over in a parking lot. On a walk in the forest, or on the beach... Since the first coronavirus lockdown began, people have become accustomed to have a "doctor's visit" in places other than the doctor's office. It is now the patient who chooses the setting of more and more medical consultations, an unexpected return to allowing health care workers into our personal spaces.

"It reminds me of house calls in my childhood," says Marie, 49. "When I was little, in northern France, we rarely went to the doctor. He was the one who came to our home." But this practice had all but completely disappeared, with only emergency calls leading to a doctor entering people's homes.

Telemedicine is creating something completely new; it's like the doctor is teleporting, except that he is never physically there. In France, both patients and doctors have long shunned this form of consultation, only seen as a solution in so-called medical "deserts' in rural areas with shortages in health care. But now in the face of the ongoing COVID-19 crisis, and the government's decision to have these virtual visits 100% reimbursed by social security, we're witnessing a boom in users: France's public health coverage fund registered a jump from 40,000 online consultations in February to 4.5 million in April, during the middle of national quarantine. And since the country has reopened, it hasn't waned in popularity. There were 650,000 online consultations in August and 1.2 million in September.

For physicians, it literally means working differently, whether they are general practitioners, otolaryngologists, oncologists, dermatologists or psychologists, like Rachel Trèves. "The bodies are missing!" says the specialist in fertility treatments. "In my practice, a lot of things are also said beyond words. The posture, the eyes, all the silent gestures are always informative... I can't hold out a box of tissues across the screen!"

Some show the doctor their apartments, like a real estate agent.

By moving away from in-person consultations, patients bring the caregivers into their own private territory. Some take the opportunity to show the doctor their apartments, like a real estate agent. The doctor sometimes has to explain that you have to get up from your bed even for a virtual appointment, or that you open the shutters so that they can see your face. Others stand in front of their pools at their second homes to show off.

These changes of scenery are also good. "I have done video conferencing from my own home," says Dr. Corinne Troadec, a Paris-based pediatrician. "And when one of my children or my dog passes in the background... finally, I have the feeling that these private intrusions into the consultation compensate for the somewhat cold side of the technology." She observed this with teenagers experiencing great psychological suffering during quarantine: "Seeing us like this, each one in their own personal space, it brought back a bit of humanity, of closeness in the relationship."

In fact, all the rituals are turned upside down. Starting with the waiting room, deserted during the pandemic. Does its new virtual configuration allow patients to be less annoyed in cases of delay?

Photo: Intel Free Press

"At the general practitioner's, the appointment never starts on time. If you wait 15 or 20 minutes, you consider yourself almost lucky! " says Lise, a 40-something patient. "After 30 minutes of standing around watching the iPad out of the corner of my eye, I finally called the secretary... The doctor was just running late."

And how should virtual doctor and patient greet each other? Very quickly, technology has provided the context for the formalities that allow you to welcome and escort a patient. The "all right, your connection looks pretty good" has replaced the "you found it easy to park?" But it's hard to completely forget the screen separating patient and doctor. "Part of my brain is still thinking about it," says Marie, who recently consulted an allergy specialist.

"It requires a different level of concentration," says Dr. Troadec. "We're tense on screen: All our attention is on the patient, who keeps us in full frame... it's tiring."

A lot is resolved in conversation.

Back to the body, of course. When you can't touch it, which is what a physical examination is all about, words take over. François (first name changed at his request), a former emergency doctor, has long acquired reflexes in the way he questions patients. This is all the more necessary when you have never met them. "People often need to be reassured," he says. "Even if you can't check up on them, a lot of things are resolved in conversation." Patients, on the other hand, are increasingly adept at using telephones and tablets to zoom in on a swollen ankle, eczema or a sore throat.

And patients are asking for more of these virtual meetings. Serge, 78, had an operation last year on a sinus tumor: "I am in regular contact with my oncologist. It's great for all the questions I ask myself as part of the medical follow-up. I don't need to tire myself along the way. The hospital visits have been spaced out as far as possible and that's just as well."

Lise recounts the treatment for her son's epilepsy: "At the beginning of the appointment, my son was with me in front of the screen. Then the neurologist let him go and we stayed to talk together. I asked him a lot of questions about the condition and the treatment. This exchange had never taken place at the office because my son was present the whole time."

To accommodate patients outside of their geographical areas and protect themselves against a deserted waiting room and falling revenues, private practitioners abandoned their last scruples during the summer. The online medical booking site Doctolib has become a must in France. Platforms such as Qare, Medicam, Consulib or CompuGroup Medical are also attracting doctors, offering to pay them. They provide the necessary tech training in just a few hours with the promise of filling up appointment books. Better still, those who were overwhelmed by calls on their cell phones or prescription renewal requests sent by email have found the solution: From now on, this overflow, which invaded privacy without resulting in more income, can be solved with telemedicine, in exchange for a special rate for specialists.

The question is if telemedicine can also treat that which ails the doctors?

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FOCUS: Russia-Ukraine War

How Vulnerable Are The Russians In Crimea?

Ukraine has stepped up attacks on the occupied Crimean peninsula, and Russia is doing all within its power to deny how vulnerable it has become.

Photograph of the Russian Black Sea Fleet headquarters with smoke rising above it after a Ukrainian missile strike.

September 22, 2023, Sevastopol, Crimea, Russia: Smoke rises over the Russian Black Sea Fleet headquarters after a Ukrainian missile strike.

Kyrylo Danylchenko

This article was updated Sept. 26, 2023 at 6:00 p.m.

Russian authorities are making a concerted effort to downplay and even deny the recent missile strikes in Russia-occupied Crimea.

Stay up-to-date with the latest on the Russia-Ukraine war, with our exclusive international coverage.

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Media coverage in Russia of these events has been intentionally subdued, with top military spokesperson Igor Konashenkov offering no response to an attack on Russian Black Sea Fleet headquarters in the Crimean city of Sevastopol, or the alleged downing last week of Russian Su-24 aircraft by Ukrainian Air Defense.

The response from this and other strikes on the Crimean peninsula and surrounding waters of the Black Sea has alternated between complete silence and propagating falsehoods. One notable example of the latter was the claim that the Russian headquarters building of the Black Sea fleet that was hit Friday was empty and that the multiple explosions were mere routine training exercises.

Ukraine claimed on Monday that the attack killed Admiral Viktor Sokolov, the commander of Russia's Black Sea Fleet. "After the strike on the headquarters of the Russian Black Sea Fleet, 34 officers died, including the commander of the Russian Black Sea Fleet. Another 105 occupiers were wounded. The headquarters building cannot be restored," the Ukrainian special forces said via Telegram.

But Sokolov was seen on state television on Tuesday, just one day after Ukraine claimed he'd been killed. The Russian Defense Ministry released footage of the admiral partaking in a video conference with top admirals and chiefs, including Defense Minister Sergei Shoigu, though there was no verification of the date of the event.

Moscow has been similarly obtuse following other reports of missiles strikes this month on Crimea. Russian authorities have declared that all missiles have been intercepted by a submarine and a structure called "VDK Minsk", which itself was severely damaged following a Ukrainian airstrike on Sept. 13. The Russians likewise dismissed reports of a fire at the headquarters of the Black Sea Fleet, attributing it to a mundane explosion caused by swamp gas.

Kremlin spokesman Dmitry Peskov has refrained from commenting on the military situation in Crimea and elsewhere, continuing to repeat that everything is “proceeding as planned.”

Why is Crimea such a touchy topic? And why is it proving to be so hard to defend?

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