Understand how we got here — and how to move forward.


December 7, 2020

Telehealth used to be considered 'callous, heartless, and cold.' Then Covid-19 struck.

Daily Briefing

    Writing in the New York Times' "Well," Jessica Nutik Zitter, a palliative medicine and critical care doctor, shares how Covid-19 has transformed the use of telehealth in her line of work, turning a mode of communication once considered "callous, heartless, and cold" into a welcome, positive "portal" for medical and familial support.

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    Nutik Zitter shares how, in March 2019, a patient in California was told via telehealth, rather than in person, that he was dying—an experience that became a scandal after the patient's granddaughter shared it on Facebook. "Newscasters questioned the humanity of a health care system that would do such a thing," Nutik Zitter writes.

    At the time, the takeaway seemed to be that "[b]ad news … should be delivered only by compassionate individuals, with good communication skills, who are actually in the room with the patient," she writes. "Not at a distance over a screen."

    But then Covid-19 hit, Nutik Zitter continues, and everything changed. With a "highly contagious virus" requiring hospitals to "strictly limi[t] visitation," virtual reunions powered by health care workers' cellphones, iPads, and other screens "were powerful and almost always positive—not only for the patient and family, but for staff. They brought humanity to days filled with stress and sadness."

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    Still, Nutik Zitter writes that she was nervous about implementing telehealth in her own work, as the "hallmark of a palliative care team's work has always been in-person, human connection." She explains, "We have been trained to provide a certain physicality, pulling up a chair, making eye contact, holding a hand. Could we really do that on a screen?"

    But her team didn't have a choice, given the epidemic, she writes. Her team prepared for their first virtual encounter: the family of a "patient who had Covid pneumonia and had been in the intensive care unit on a ventilator for weeks." At the time, Nutik Zitter was concerned that the family would see her struggle with the technology and think that she "didn't know what [she] was doing, [and] that [she] would be perceived as a fraud" for not being with the patient in -person.

    However, when the meeting finally started, "it turned out to be less challenging than we had expected," Nutik Zitter writes, "as did all the ones that followed." She explains, "Any initial doubts I had about this medium were erased by the relief of families connecting in this desolate time." While they "didn't have much of a choice," given hospital visitation restrictions," their "heartfelt appreciation of a physician's presence was a striking contrast to the national sentiment expressed just 12 months earlier," when the California patient's experience made news headlines.

    As for herself, Nutik Zitter writes that she adapted over time to the new medium, learning to "better translate [her team's] presence in an online format." For example, in instances when she'd normally touch or hug a patient, she now puts her "hands over [her] heart," and instead of looking directly into patients' eyes, she now makes sure to look directly at her computer's video camera.

    "I discovered I can be compassionate on and off the screen," she writes, "which made me wonder: Is the most important factor for delivering excellent care physical proximity? Or is it depth of focus, and quality of communication? Is it dependent on technology or the person using the technology?"

    Over the course of her experience, Nutik Zitter said she's realized that "telehealth is not merely a pale substitute for in-person care, but rather a viable alternative" that enables patients to see loved ones from all over the globe, while minimizing exposure risk and conserving PPE for frontline workers.

    "While I look forward to a time when face-to-face interactions are the norm again, I am grateful for the wide acceptance of this new tool that will continue to help us support patients and families everywhere," she writes, concluding, "We've learned that it's not about the medium, it's about the message, and the way it's delivered" (Nutik Zitter, "Well," New York Times, 12/1).

    Resources to help you deliver effective palliative care

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    Many organizations still struggle with misconceptions about palliative care and entrenched practice patterns, as well as insufficient reimbursement. Learn how to confront the cultural and clinical barriers to effective palliative care.

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