Correspondence| Volume 52, ISSUE 10, P1102-1103, October 2020

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Will “Video kill the Radiostar” or is zooming just a pandemic transient Hype? Some cautionary notes

  • Guilherme Macedo
    Corresponding author.
    Gastroenterology Department, Centro Hospitalar e Universitário São João, Porto, Portugal

    World Gastroenterology Organization Porto Training Center, Porto, Portuga

    Faculty of Medicine, University of Porto, Portugal
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      To the Editor,
      Throughout these last 3 months, many Gastroenterologists have been facing the thrills of substantial video conferencing, watching webinars, conference calls, discussing new strategies and solutions while struggling not only with these challenging times but, unexpectedly for them, with bandwidth and video resolution issues. We all acknowledge the extreme usefulness of this tool, during times of uncertainty and when prompt sharing of information and cross talking is seriously needed. But after some weeks, surprisingly, we also recognized that the amount of time spent with these virtual meetings -chats, seminars and so on, - was similar to our previous ways of communication, not as productive as our expectations were and that we lacked social interaction, not only with our colleagues but also in the setting of telehealth, including with our well-known patients. While video conferencing replaced face to face communication, we progressively became less satisfied, more exhausted and somehow frustrated, with a sense of unfulfillment. For sure, the usefulness of these video applications is undisputable, specially in moments when acute decisions have to be made and new ground rules need to be immediately settled. But as the time for restoring our clinical practice is on the move (and busy gastroenterologists do spend lots of their time using physical interaction not just through scoping), some thoughts or some cautionary notes could be raised concerning this zooming hype. Mainly, we have to consider the lack of sensorial experience, the avoidance of going straight to the emotions, so important in the communication process. What type of coordinates should we keep in mind?
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        Touching is trusting: Doctors have expanded this communication skill thoroughly, not only with their patients but also between colleagues. The rituals of exchanging cards or holding your badge or simply handshaking, are examples of physical interaction that enhance communication and even trustfulness. It sets the mental stage for sharing ideas and prepare ourselves to the other, making our mind ready for cognitive challenges or even disruptive proposals from our counterpart. Contact unleashes dialog, clinicians confirm this in their daily practice.
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        Seeing is believing, in the sense that watching other´s nonverbal cues has been recognized, for long, that they stand as precious tools to provide insight and understanding of how communication flows. Body language expressions are mostly lost on a computer screen; posture, body orientation, eye contact, side glances or any cross-person interaction is jeopardized and framed in your laptop. One camera fits all, and many of the features of non verbal behavior are simply left underestimated. The bidimensional square of the screen also encourages your own self-consciousness repeatedly, and introduces an element of distraction, which takes you out of the presenter or the presentation you needed to pay attention.
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        Anosmia, a common and peculiar symptom of COVID -19, provocatively reminds us the possible importance of smell and its role in communication that is not conveyed only through words, facial expressions or posture. Beyond the discussion about the neurobiology of chemical communication, where human pheromones remain a controversial issue, some chemosignalling outside conscious awareness can play a role in providing further pieces in the emotional puzzle. This is the reason why brands try to engage consumers providing immersing experiences that stimulate all our senses, in order to build up pleasant memories and enjoyable emotions. Not an issue in front of a computer screen: that “sensorial landscape” is also missing.
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        Any room for learning? If we consider the concept of Built Pedagogy as an important paradigm (“the architectural embodiments of educational philosophies” as Monahan defined in 2002), we immediately conclude that in a video conference, with all the contextual cues homogenized, much of the impact of location in every aspect, including the pedagogical reinforcement you could benefit from, is almost completely vanished. Not only the physical space itself around you, but the plethora of sounds, movements, visual stimuli that you unconsciously would uptake from an appropriate learning environment (even if it was a convention center!). Instead, you need to make your own checkings, assuring whether your private space could be shared, or if other unexpected events (familiar, for example) occur during video calls. Furthermore, in several occasions, you might not have the time to build an appropriate momentum for holding a conference: you are almost teleported into a meeting, without a transitional pathway or having a preparation time between where you were or what you were doing. In a sudden moment, you are under the spotlight of the videoconference.
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        Trading burn-out for mental fatigue is not a great deal: video conferencing may trigger both, and in fact both conditions may be mutually fueled. Mental fatigue occurs and is triggered by prolonged cognitive activity. Eventually it will hamper productivity and overall cognitive function. In many circumstances its symptoms are well recognized when following prolonged strict rules of confinement and isolation, just as those we are living in the COVID 19 pandemic: irritability, insomnia, lack of motivation. Using extensively zooming for social or business meetings and also for learning purposes, one may find that constant decision-making processes exhaust executive functions, and cognitive overload could develop, specially if committing to more tasks that time allows you to finish. If procrastination ensues, anxiety increases, which in turn may deplete mental energy. The plural social networking and extra cognitive processing that consecutive videoconferencing hinders, are unconsciously missed and set the stage for brain fatigue.
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        Keeping in mind with these new challenges that this unprecedented reality has created, it is fair to give credits to the current tools of videoconferencing, and how they helped doctors to bridge the distance between colleagues, their families or their patients. These digital or virtual tools were extremely valuable and helped us to navigate through these difficult times. But it should never be forgotten that empathy through caleidoscopic physical inputs is irreplaceable and will stand as a powerful pathway not only for doctor to doctor interaction but also for doctor and patient communication, a complex process so wonderful as fundamental for their health, both for patients and for clinicians.

      Declaration of Competing Interest

      All authors disclosed no personal conflicts of interest or financial relationships relevant to this publication. There is no funding declaration.

      Author contribution

      Prof. Macedo was responsible for paper writing and was the article guarantor.