Before Illinois went under a stay-at-home order, Dr. Ronke Pederson said her therapy sessions would begin when she walked into the waiting room to greet her patients. She’d observe their appearance, their body language, their demeanor.
Then, they’d go into her office and she’d shut the door.
“Behind the shut door, they are free to remove that filter that they may use in the world,” Ronke said. “They may start crying as they recount experiences since our last session, and at this moment, when I'm sitting with them face-to-face, there's this transformation from the world to my office and our session is in full swing.”
This connection between doctor and patient is what medicine is all about, Ronke said — and it’s also what she misses most about not seeing her patients in-person at her psychiatry practice at Northwestern Medicine.
As telemedicine has become a more routine health care practice across the country because of COVID-19, Ronke now speaks with her clinic patients on the phone or through video chats for their sessions. She’s tried to make up for that lack of face-to-face observation.
“I use my sense of hearing; I try to adapt to using other senses more prominently, attempting to hear the subtleties in their tone of voice, the pauses between phrases, and sometimes I hear their subtle tears, the breaking of their voice,” Ronke said.
The stress of COVID-19
Ronke said she’s noticed that the stresses her patients typically deal with in their daily lives — often leading to experiences of depression or anxiety — have been exacerbated by the “invisible enemy” of COVID-19. Patients who were already dealing with mental illnesses or disorders like mania, for example, are now even more compromised in their ability to cope.
“I do see a lot of patients — and regardless of demographic background … regardless of socioeconomic status, high or low, old, young — experiencing difficulty coping because of the impact of COVID-19,” Ronke said.
And Ronke isn’t just seeing more strain on her patients, but also on her colleagues and even herself. Since the coronavirus has spread so rapidly, Ronke said health care workers no longer have the “time, space or ability” to take a step back and process the changes to their environment.
“You just have to go back to that shift,” she said. “You have to go back and continue working.”
Ronke said that before COVID-19 changed the pace of a typical day at the hospital, she and her colleagues would often get together to support one another after experiencing stress or patient losses. There’s been no time for that during the pandemic. And she says this inability to process trauma together has led to people feeling isolated.
“In a lot of cases, health care providers are trained to absorb stress and are trained to kind of take the brunt of the struggles that they're experiencing and just get up and keep moving,” said Ronke. “And all of a sudden we're having to unlearn this sense of ‘I can do it all.’”
Prioritizing mental health now and when the pandemic is over
The advice that Ronke gives her patients and also follows herself is the same: be kind and patient with yourself, and acknowledge that this is an anxiety-inducing time. She also advises patients to learn what they can control in this moment of unpredictability and hone in on those factors — which is something she’s doing in her own life.
“Part of the journey has been figuring out the things I can control and the things I can’t control, … and I think that’s a universal concept to embrace,” she said. “And I think one of the things that has helped my mental health is being able to not necessarily on paper, but mentally list those things.”
Although the pandemic has presented many challenges to mental health care, Ronke is hopeful that this somewhat universal experience of exacerbated mental stress will spark a change in our societal approach to mental illness that will outlive the time of COVID-19.
“I hope that some of the stigma associated with mental health is reduced through this,” Ronke said. “I hope that there is this greater push to normalize our psychological and emotional experiences in a way that allows people to seek help and seek care and get support.”
Ronke hopes, as soon as it’s safe, to return to seeing her patients in person.
“I understand the important need to limit our exposure to COVID-19 for both patients and staff, and I agree with this approach at this time,” Ronke said. “I hope, though, that once we are past COVID-19, we don't think virtual care is an adequate replacement for face-to-face encounters in medicine.”
Mackenzie Crosson is the interim multimedia producer for Curious City. Joe DeCeault is a senior producer for WBEZ. You can follow him on Twitter at @joedeceault.