Category Archives: Models

Examples we can productively study

The Rise of Telehealth

Well down the path of protecting health care workers with vaccines and masks, it remains for insurance companies to decide whether to still cover virtual visits.

Just a few years ago most people who studied health communication expressed doubts about the value of remote health “visits.” A phone or video appointment with a professional might be fine for a patient or client isolated in a remote location. But more recently, the more typical telehealth “visit” has gone local, with patients talking to a provider just a few miles away, usuallly via some version of Zoom.  Indeed, no person with symptoms of COVID was really welcome in a typical medical office, especially when vaccines were still months away.  Rates of virtual visits for all types of care are now at about 35 percent.

I certainly was among the skeptics, believing that a live face to face encounter is far preferable. And health professionals note that if they take time to notice, they may learn more about a patient’s condition in the small ways they present themselves during an in-office examination. But COVID obviously made telehealth “visits” a safer alternative.

Now, well down the path of protecting health care workers with vaccines and masks, the question remains for insurance companies whether to continue to fully reimburse health providers for virtual visits. And since states pitch in for federal insurance, many are grappling with what they will reimburse. Some state leaders have expressed concern that virtual visits are easy to abuse, and maybe little more than a glorified phone call. Then, too, it takes some planning and skill  to do exams remotely.

The behavioral health therapists I know bridle at the suggestion that they do any less for a virtual visit. Some argue that they often achieve more because they have to listen closely to a patient’s or client’s descriptions of their world and concerns. Not surprisingly, a face on a flat screen sometimes gives away very little. With video, the work and the payoffs are ironically in the process of active hearing and listening: something we are less apt to do in the presence of a lot of visual stimulation.

 

The Human Glitch of Required Video

There’s also an unexpected glitch with a mandate that specifically requires video visits. Many older patients  and clients are hardly in the position to use a computer or smart phone to connect with a professional. What is second nature to most of us is often awkward for a senior with limited abilities. They may not be able to pull off a video chat, with all the normal prerequisites of finger dexterity, access codes, Wi-Fi connections, and basic management of the software. And, to be frank, there aren’t enough staff around these folks to stand by and help.

For these seniors, phone visits are often adequate and preferred. They’ve grown up with telephones. So far, through much of the pandemic insurers have usually allowed calls to be counted as full “visits.” But those who pay our healthcare bills have a hard time imagining that seniors would be challenged to manage Zoom calls. Most surely need a more active imagination to understand why what is essentially video conferencing is poorly suited to an assisted living or nursing home situation.

There is also an additional advantage to audio-only visits. They allow a person to give up the natural anxiousness that comes with the offering of oneself to the gaze of others. This is no small matter, as anyone with a teen in the house knows. Almost all of us worry about how we will look to others. It’s part of the human condition. Face to face meetings require, in sociologist Erving Goffman’s perfect phrase, “the presentation of self.” Our presence in the same space with others carries the double burden of trying to meet perceived expectations, and implicitly inviting others to judge the-outer most shell of the self.

To some extent that still happens with voice-only messages.  But the so-called “white coat syndrome” is probably reduced. We can retain more of our personal “front,” making it easier to focus on what we are saying. For now, it remains to be determined how routine medical visits will look in the coming years.

Hearing is Our Newest Sense

The pop recording “High the Moon” was the audio equivalent of an early photograph, or the first photocopy of an original. It changed everything. 

Granted, the heading for this piece is a bit of an exaggeration, but not by much.  In broad terms, a bit less than 100 years ago sound arguably became the premier source of leisure and pleasure. Think of radio, recordings, sound on film, concerts and dances, audio reports of events, and the growth of music education. These are just a few of the cultural landmarks represented by the capture of ephemeral sound on the medium of magnetic tape.

To be sure, Thomas Edison starting making stylus-in-groove recordings in the late 1870s.  But the German invention of audio tape during World War II perfected recording, creating  a level of accuracy in musical reproduction that surpassed the early Edison technology.  With tape, sound as we know it began to throw off its previous history as a subordinate sense.  More recent digital recording developed in the 1980s was certainly a technological breakthrough, but offered only slightly better sound. Magnetic tape provided the true gateway to the world of captured auditory content.

The pathway to this rebirth was certainly helped by the growth of what was then the supermax medium of radio in the 1930s. Radio networks and their stations would also benefit from new tape machines made by Ampex and others, adding stunning clarity and opening up a range of recording options.

In the recording studio the new system yielded greater clarity, and allowed for many synchronous tracks. A musician could now create amazing audio effects that would have been difficult to duplicate in live performance.  As mentioned in my recently published The Sonic Imperative, one particular song especially turned jukeboxes across the nation into the musical equivalents of slot machines. The only difference was that most jukeboxes came up with the same winning result: Les Paul and Mary Ford’s How High the Moon. Rarely has a single pop record meant so much. Prior to 1951 few had ever heard anything quite like its sound-on-sound and multi-track effects. It would signal the acceleration of music processing that continues down to the present.

A little more about that song. . .

Our dilemma is that we live in a loud world our ears were not designed for. Think of noise as aural trash: stuff that piles up around us that we hardly notice because it has no visual presence.  But its there: at music concerts where the sound is punishingly loud, or in the everyday equipment of modern life like leaf blowers, hair dryers and vacuums.  Previews shown in movie theaters, for example, regularly play at about 100 dB: only slightly less than standing at the end of an airport runway.  With this kind of noise, a person’s ears will not survive intact to adulthood.  This is why one in three older adults have hearing loss. It turns out that our newest sense is also the most vulnerable.