By Shelby R. Lies, MD

Our practices have changed significantly with stay-at-home orders and physicians quickly transitioned to offering telemedicine appointments. Though several virtual applications work flawlessly, many of our less technologically-inclined patients limit us to telephone visits, which are dependent on the patients’ medical education and interpretation for history-taking. I have discovered that in these blind encounters the practitioner REALLY has to keep terminology SIMPLE. Though we have been trained for so long to use accurate medical language, the lay person prefers to use the top/back of the hand, the bottom/palm as opposed to dorsal and ventral. The big knuckle, middle knuckle and tip replace the MPJ, PIPJ, and DIPJ. They bend the finger down to make a fist instead of flex, and straighten, not extend.

With the advantage of video, we can ask a patient to point, abduct thumb, cross fingers, and even demonstrate maneuvers to replicate. This method allows us to continue to hone our keen observation skills such as in Froment’s or Jeanne’s sign. 

Now that clinics are starting to open up to a new normal capacity, I was asked how I wanted to continue using telehealth. I still think most of hand exam requires in-person touch to manipulate joints and percuss to assess fracture healing and Tinel’s sign. In fact, the reason I fell in love with the field is that I could listen, feel, make a focal diagnosis, and have a distinct plan to fix it rather efficiently. There are, however, tele-visits for routine follow-ups that could significantly decrease the travel and time burden for our patients and staff, especially those that live far away. 

During the coronavirus pandemic, restrictions on elective surgeries broadly decreased the scope of many of my plastic surgery colleagues; but, fortunately, hand surgeons reap the opportunity to continue operating on distal radius and open hand fractures, flexor tendons, and even replantation. I was able to reattach a left ring finger such that a patient could don a wedding band. Most facilities ask surgeons to leave the room during intubation for “anesthesia time” and return to a field with the extremity prepped and draped. The ability to post surgeries without seeing a patient in person and avoiding as much exposure time to the patient’s face during emergent surgeries can make one miss the personal connections that we treasure as compassionate doctors. There is some humane gratitude missing and it feels more akin to a technical business at times; but, I do think the mass media has done a fair job to represent the frontline workers risking their own health and even families well-being with potentially bringing the virus home. Our training has certainly given us an advantage to avoid contamination and control spread; and, I think it continues to be our duty to disseminate our knowledge to get through this safely. With that said, COVID-19’s impact has emphasized the importance of a close-knit family and social support system. I am glad that we can remain as a community through electronic mail perspectives such as this. 

Virtual regards,
Shelby R. Lies M.D.