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
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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La Sagrada Familia Delayed Again — Blame COVID-19 This Time

Hopes were dashed by local officials to see the completion of the iconic Barcelona church in 2026, in time for the 100th anniversary of the death of its renowned architect Antoni Guadí.

Work on La Sagrada Familia has been delayed because of the pandemic

By most accounts, it's currently the longest-running construction project in the world. And now, the completion of work on the iconic Barcelona church La Sagrada Familia, which began all the way back in 1882, is going to take even longer.

Barcelona-based daily El Periodico daily reports that work on the church, which began as the vision of master architect Antoni Gaudí, was slated to be completed in 2026. But a press conference Tuesday, Sep. 21 confirmed that the deadline won't be met, in part because of delays related to COVID-19. Officials also provided new details about the impending completion of the Mare de Déu tower (tower of the Virgin).

El Periódico - 09/22/2021

El Periodico daily reports on the latest delay from what may be the longest-running construction project in the world.

One tower after the other… Slowly but surely, La Sagrada Familia has been growing bigger and higher before Barcelonians and visitors' eager eyes for nearly 140 years. However, all will have to be a bit more patient before they see the famous architectural project finally completed. During Tuesday's press conference, general director of the Construction Board of the Sagrada Familia, Xavier Martínez, and the architect director, Jordi Faulí, had some good and bad news to share.

As feared, La Sagrada Familia's completion date has been delayed. Because of the pandemic, the halt put on the works in early March when Spain went into a national lockdown. So the hopes are dashed of the 2026 inauguration in what would have been the 100th anniversary of Gaudi's death.

Although he excluded new predictions of completion until post-COVID normalcy is restored - no earlier than 2024 -, Martínez says: "Finishing in 2030, rather than being a realistic forecast, would be an illusion, starting the construction process will not be easy," reports La Vanguardia.

But what's a few more years when you already have waited 139, after all? However delayed, the construction will reach another milestone very soon with the completion of the Mare de Déu tower (tower of the Virgin), the first tower of the temple to be completed in 44 years and the second tallest spire of the complex. It will be crowned by a 12-pointed star which will be illuminated on December 8, Immaculate Conception Day.

Next would be the completion of the Evangelist Lucas tower and eventually, the tower of Jesus Christ, the most prominent of the Sagrada Familia, reaching 172.5 meters thanks to an illuminated 13.5 meters wide "great cross." It will be made of glass and porcelain stoneware to reflect daylight and will be illuminated at night and project rays of light.

La Sagrada Familia through the years

La Sagrada Familia, 1889 - wikipedia

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