How COVID-19 is changing the way we connect
‘Sometimes clients are in their bedrooms in PJs - and I’m in track pants.’
If there’s an upside to lockdown then for some APDs it’s telehealth. After a downturn in March as the pandemic kicked in, the introduction of Medicare benefits for telehealth in April increased bookings for Jo Money, a Melbourne-based APD specialising in eating disorders.
But it’s a mixed blessing. While she’s busier than ever, the upturn reflects the distress the pandemic has imposed on people with eating disorders.
“Eating disorders can often develop as a way of controlling anxiety or feelings and the pandemic has added another layer of complexity,” she says. “For some people the empty shelves earlier in lockdown were more triggering than anything else. Some clients have rigid ideas about which foods or brands can be eaten with minimal anxiety and the shortages meant they couldn’t access foods they see as ‘safe’.“
Boredom is another problem when people can’t use their normal strategies for coping like seeing friends, eating out or the gym. Whether you’re sitting at home trying to make yourself eat something- or trying not to binge, it’s equally difficult, Jo says.
“I’m also seeing more adolescents with eating disorders - not only because their anxiety increased but also because spending more time at home made it easier for parents to recognise a problem, “she adds.
Building a rapport via video
At first Jo Money was apprehensive about telehealth in case it made it harder to build a rapport with clients or respond to non-verbal clues.
“But video can work well and be helpful for first time clients who may feel overwhelmed by coming into the city and meeting a new person. Younger clients are also used to talking to their friends via screens. Some people talk to me from their bedroom in their pyjamas or even with a weighted blanket which they find helpful for anxiety.”
And while clients talk from the comfort of home, so does she - and that helps build a rapport too, she says.
“You can be more authentic - I’m in track pants and no makeup, and there are family photos in the background. When you think about the usual dynamics between health professional and client in a clinical setting, this is different. Clients can feel relaxed and connect more. I’m still professional but I’m also human - and we’re all in this pandemic together.“
Reaching rural areas with telehealth
Telehealth was an easy transition for Joanna Baker, an APD specialising in IBS and food intolerance who was already using Zoom with clients overseas. After a quiet March, local bookings climbed in April and business has grown by 30 per cent. Telehealth has also opened up her practice to people in rural communities with less access to dietitians specialising in IBS.
But like eating disorders, IBS can be made worse by stress and for some clients the pandemic has exacerbated symptoms.
“For some people the problem has been isolation while for others spending more time with family can be stressful,” Jo says. “Food shortages have sometimes made it hard for clients to access foods they rely on like gluten-free pasta or pasta sauces without onion. But others report feeling more relaxed because working from home means easy access to a toilet while some have decided that lockdown is a good opportunity to try an elimination diet.”
More flexibility, fewer skipped appointments
Vinci Chan-Duffell, a community dietitian working with DPV Health in Victoria’s Plenty Valley, telehealth hopes telehealth is here to stay.
“Some clients seem more at ease over the phone and it gives them flexibility - there’s no need to physically go somewhere for an appointment. Missed appointments are usually quite high in the community setting, especially for dietetics. With telehealth, I’ve had only very few instances where I couldn't contact a client for an appointment. If we can offer a mix of telehealth and face-to-face consults for clients to choose from in the future, we could work more efficiently.”
Although she uses video, Vinci says most clients find phone consults easier, especially elderly clients.
“We still manage to build a rapport with our clients quite well over the phone. A lot of them express gratitude for our calls and report feeling comforted by someone reaching out to them during lockdown. “
But the pandemic has made it hard for many clients to manage their eating and their weight, including patients with diabetes and heart disease, she says.
“Some are afraid to go out and exercise and for people working from home it’s easier to eat more. It’s also difficult to know how some clients with chronic conditions are managing because they’re reluctant to see their GP for regular blood tests as they would normally.
“Many clients admit to non-hungry eating when they’re home all day. But encouraging them to focus on their hunger cues and using mindfulness has been a good starting point. It helps shift their mindset from negative feelings about overeating or not exercising, to just slowing down and paying more attention to their bodies in a non-judgemental way.
“I remind clients that now’s a perfect time to practice self-compassion, nurturing and speaking kindly to themselves when it comes to their bodies and their health - we’re all going through a difficult time. “