Telehealth consultations deprive us of the chance to play up the pain

And I am thinking of something over and above the notion that perhaps a remote consultation may not be as medically efficient as face-to-face pow-wow. Many common, knockabout ailments are surely medicinally, pragmatically, perfectly well tackled over the phone.

No, I am grappling with a different, deeper, more elusive species of dissatisfaction; and, since is this column's motto (after Socrates) that the unexamined life is not worth living I have been examining what it is about these remote consultations that doesn't float a sensitive patient's boat.

I had already pretty much worked it out for myself when, helpfully, up in my online feedbox there popped Justin E. Smith's forbiddingly-titled piece A Surfeit of Black Bile: Depression, Melancholy, and the Historical Ontology of Wretchedness.

In spite of the title Smith writes entertainingly and like an angel, albeit an angel who has had considerable personal experience of the mental health systems in France and in the USA. I took an instant liking to Justin when his piece entertainingly opened: "After some initial shopping, I settled on my current Parisian psychoanalyst principally in view of the original Francis Bacon painting hanging on his office wall.

"I found [his office's decor suited my spirit. 'This is my kind of place', I thought, and I stayed, week after week, 110 euros at a time, opening up about myself, little by little ..."

Not enough of us choose our health professionals on the basis of the decor of their consulting rooms but your columnist, a sensitive aesthete, has always taken this into account.

I have never gone back a second time to a psychiatrist, dentist, podiatrist or physiotherapist whose rooms' furnishings and artworks appal me. My model in this is fellow aesthete Oscar Wilde, who chose to die rather than go on living with the terrible wallpaper in the room in which, unwell, he was forced to lie.

But I have digressed, because I am here to report that while Justin Smith's whole piece is a terrific read, one particular passage leapt out at me because of my present preoccupation with telehealth and its eerie inadequacy.

"We say different things for different audiences," he muses, "whether in intimate dialogue with a loved one, or displayed as a curiosity like the eloquent ape in Kafka's Report to an Academy.

"This means that at least to some extent all life is a 'performance', which we do not have to interpret in any radical way. We only need to go as far as to acknowledge that our encounters in everyday life are not just a matter of showing up, of hauling our body out of domestic storage; these encounters are also a 'presentation of the self' which requires at a minimum that a person make choices about how the self is presented, in what light, which angles to showcase, to what ends."

Even before reading this it had already struck me our visits to our GP are our presentations of ourselves. Our performances.

In her brilliant essay On being ill Virginia Woolf makes much of how being ill gives the patient a special, limelit status and of how being ill sensitises and tenderises our senses in ways that may incline us to want to literally act up.

If all the world's a stage then certainly a doctor's surgery is, and the patient, strutting that stage, is an actor, starring, playing a leading role. When he or she (the patient) is on that stage in the flesh then there is enormous scope for performing. So for example one's description of a harrowingly sleepless, pain-ruined night gives opportunities for all sorts of doleful facial expressions, for illustrative winces and grimaces and simulations of agony.

Surely the patient-actor's performance even begins at that moment when the doctor comes to the edge of the waiting room and beckons us. The act of walking in his or her direction involves (consciously or not, and I am not suggesting all this 'acting' is necessarily feigned, artful and narcissistic) performances of one's gait and often eloquent body language.

Oldies (and I am 76) increasingly find themselves going to their GPs with locomotion issues and the walk from the waiting room to the consulting room is a chance for one's gait (is there a limp, shuffle or trudge with lots of creaking noises from rusty joints, or is there perhaps a panther-like spring in the step?) to announce what state one is in.

Every actor who ever portrays Hamlet in Shakespeare's masterpiece enters and leaves the stage with a gait and manner that tells us something of what is going on at that moment in his excitable, moody Danish mind. Similarly when I go to see my GP I want to be as helpfully thespian as possible.

To only go to the doctor because one is poorly and then to just be quietly undemonstratively miserable is a wasted opportunity to reach for that virtual Academy Award.

No wonder then most of us, consciously or subconsciously, go to the GP in the same spirit in which a Shakespearean actor makes his or her entrance on to the stage of The Globe.

Telephone consultations take all of the theatre out of consulting the doctor, and a life lived without theatricality is not worth living.