Lessons Learned from the Pandemic: The Advantageous Positioning of TCM Expertise for Telehealth Consultations with Covid Patients

During telehealth consultations, the reliance on verbal communication – rather than the combination of verbal and corporal aspects of communication that characterise face-to-face medical consultations – presents an inherent limitation. As patients’ descriptions of their symptoms inform a greater number of telehealth diagnoses, an additional limitation emerges: telehealth more frequently replaces first-hand clinical observation with second-hand accounts, potentially compromising accuracy. Moreover, the lack of personal contact during telehealth sessions potentially disrupts the patient-practitioner bond, which has been correlated with, among other effects, patients’ likelihood of complying with medical advice. With its diverse diagnostic tools and emphasis on an individualised approach, TCM is well positioned to overcome these limitations. As part of a larger study on the sociolinguistic aspects of therapeutic alliances during acupuncture consultations, we sat down with Dr Miu Ha Chan of PolyU’s TCM clinic to discuss her approach to telehealth consultations with Covid patients.

Alternative modality: The tongue as a diagnostic tool
Tapping into the full range of TCM diagnostic tools – including observation (visual, auditory, and olfactory), inquiry, and palpation – is, of course, impossible over the phone; however, these additional options offer some alternative modalities that adapt well to the conventions of social media. With the easy sharing of tongue photos over messaging platforms, tongue observation represents an apt example. Many TCM patients are well practiced at sticking out their tongues during face-to-face consultations. As Dr Chan explains, “In Chinese medicine theory, every part of our body is related to the inside. But we say that the tongue is also related to our whole body.” In the absence of a body to inspect, tongue photos, thus, provide directly observable information about the patient’s condition that is otherwise difficult to attain during telehealth sessions.

Individualised Care:
Building on this information, Dr Chan can then probe the specifics of each patient’s illness: “It’s a kind of reference. You still need to investigate the case by asking for more details.” To illustrate this point, Dr Chan refers to two of her elderly (90+ year-old) patients with co-morbidities. Checking with them every two days over a three-week period, she closely monitored the colour, coating, and cracks of their tongues while also considering their reported symptoms. Both patients sought treatment for COVID-19, a virus with which Dr Chan was already deeply familiar; nevertheless, she evaluated them on a case-by-case basis: “Even though the diagnosis, the illness, the name of the illnesses are the same, the treatment can be very different.” In this way, Dr Chan tailored her recommendations to suit each patient individually. This approach, she explains, aligns with core tenets of TCM that emphasise the uniqueness of each patient's condition.

Fostering therapeutic alliances:
This demonstrated concern for individual patients also communicates compassion, which, according to Dr Chan’s TCM background, is integral to 大醫精神 (dài yī jīng shén), “the spirit of being a doctor”. In discussing her approach, she underlines the importance of patience for building rapport and, ultimately, enhancing the healing effect: “If you are willing to understand more, they [the patients] will talk more…When they come back they will have more to say to you that can improve the effect of the treatment.” This direct connection between compassion, full engagement with each patient, and treatment outcomes highlights Dr Chan’s use of TCM-based principles to overcome the impersonal aspect of telehealth consultations.

Telehealth innovations developed during the pandemic have now become standard components of medical practice. Moving forward, telehealth communication that incorporates alternative modalities, an individualised approach, and a willingness to understand each patient will position it as an increasingly valuable resource for medical care.

This article is authored by Dr Anne Ambler Schluter, Dr Carol Yu, and Dr Margo Louise Turnbull of the Department of English and Communication.