This provider triage call is scheduled for 12:45 p.m., shortly before my first telemedicine patient of the afternoon. I look at the clock and shift in my chair. Perhaps I could give it a go now, and get it done. There's no telling how these conversations might play out: a brief interlude may morph into a one-act play.

I prepare the provider triage document in advance, transferring data from the medical record: name, date of birth, parental contact, chief complaint, and phone number, taking care to check the stream of digits twice. I punch the numbers in on the telephone keypad. Shortly, a woman's voice answers.

“Hello,” I say, identifying myself, and immediately launch into an excuse. “I know this call is scheduled for the afternoon, but I had an opening now and thought I'd check with you. Is this time okay?”

“Certainly,” the woman says. “I've been working from home since the pandemic hit—I can make the time.”

“Good. I understand you had concerns about separation anxiety in your 4-year-old son?”

“Yes, I guess that's what you'd call it. I mean, do you see that at this age? My husband thinks I'm making this out to be more than it is, but I'm worried. I don't think it's normal for my son to be acting like this.”

“What's going on?” I ask.

“Well, I work from home—online, you know. I set up my office in the bedroom. We've hired a nanny to watch the children during the week. The 7-year-old and the baby do fine, but my 4-year-old won't leave my side. He comes into my room at least once an hour. He's usually tearful, but when I ask him what's wrong, he just says he misses me. I can't figure out what the problem is, but it seems to be getting worse. I'm not sure what to do.”

“When did all of this start?”

“Sometime over the past 2 months. He started preschool last fall—that was a bit of an adjustment, tears every morning for the first week—but he got used to the routine. Then the pandemic hit; they closed the school. We sheltered in place like everyone else. My oldest transitioned to online learning, but my 4-year-old was too young for that. It's been tough trying to keep him occupied. I hired the nanny to help. She takes the kids outside to play, but he gets weepy and comes in to find me.”

I ask about the boy's appetite and sleep—both largely unchanged—then delve into family history. “Anyone suffer from anxiety or depression on either side?” I ask.

After a brief pause, she says: “Yes, I've suffered from anxiety my whole life. So has my mother and my sister, and there's some bipolar issues on my husband's side. Do you think my son might have something like that?”

“There may be a hereditary component—anxiety does run in families—but we're immersed in unprecedented times with this pandemic. Tension runs high in the home. As parents, our first inclination is to reassure our children as best we can; but they feel it, too.

“What can I do?”

“You can ask a couple of open-ended questions, then sit and listen. Give him permission to tell you his concerns, then validate them and offer reassurance. Most young children want to know that their parents will be there for them, that they are loved, and that things will be okay.”

“And if that doesn't work...?”

“Sometimes a few visits with a professional counselor can help. It's always good to have a backup plan. I can give you some names, if you'd like.”

“I'll think about it. I have to talk to my husband first. He's not onboard with this. He thinks I should take a tougher approach.”

“It would be good for you to have that conversation. It's best if parents are consistent in their approach to the child. See if you can work through your differences and come to an agreement.”

“I'll let you know how it goes.”

As I hang up the phone, I note the time: 22 minutes have elapsed. I complete my note, sign the encounter form, and circle the billing codes.

Ordinarily, I would not bill for telephone advice; but the pandemic has changed all of that. Now we are forced to recoup whatever revenues we can, just to survive.

Medicine has morphed into a profit-driven business. Like attorneys, we clinicians are directed to bill for our services at every opportunity.

Time is money, the clock is always ticking—but somehow through all of this I have come to reconsider my role in this once-honored profession.