As a primary care physician in a university community health care system in Massachusetts, I received a quick introduction to telehealth this year. A few days after Massachusetts declared a state of emergency in response to the spread of COVID-19, almost all of our patient visits became telemedicine visits. Our staff contacted patients to inform them of the different ways to contact their doctor. Many could access health care through a health app connected to their health care web portal, or by phone or video call. The enormous potential of telehealth appeared to me in a few weeks. Yet I also understood the need to overcome certain barriers to widespread access to telehealth and provide additional support, as illustrated by some of my stories below.
Chronic conditions and COVID-19: How has telemedicine helped?
Healthcare providers like me have had to quickly adapt our clinical practice to make the best use of technology. We have found that a combination of phone calls and video calls allows us to continue to monitor people with chronic conditions, such as diabetes, high blood pressure, and heart and lung problems. The video was particularly useful in assessing who should be seen quickly for a health problem, while avoiding unnecessary exposure to COVID-19 in emergency rooms if possible.
Our organization has developed an intensive community management strategy for COVID-19. For example, we were able to educate patients and their families on how to avoid contracting or spreading COVID-19. In addition, we have used telehealth to reduce the pressure on emergency and hospital systems, conserve personal protective equipment (PPE) and reduce health care costs. Using telephone and video triage, clinicians could identify people who were so sick that they needed to be seen in clinics or in the hospital. In recent months, telehealth platforms have helped our primary care providers and specialists to communicate between different clinics, through meetings and virtual meetings.
Telemedicine can marginalize non-English speakers
Translation resources are essential to the inclusion of certain patients, including a woman I will call Maria, who had recently moved from Brazil outside of Boston with her husband, Jose, and two children.
“Muito obrigado!», She exclaimed several months in our telehealth visits. “I feel like a new woman now. My husband and I would like to express our gratitude to you. The couple contacted our health services because of an itchy rash and a rash all over their body. Being non-English speaking, they struggled to find a health care provider who could help them. Fortunately, the combined help of our staff and our health interpreter services helped the couple access the patient portal and video technology. Thanks to teledermatology consultations, we were able to cure them of bacterial, fungal and parasitic skin infections over a period of two months. Having translation resources to overcome the language barrier was essential for the success of telemedicine in this case.
Internet and smartphones can be a barrier
In the age of ubiquitous smartphones and high-speed Internet, it is easy to lose sight of people who do not have access to Internet connections or smartphones. Recently, I treated Félix, a 77-year-old man who had previously been in prison for 40 years. Suffering from a number of illnesses, including hypertension, heart rhythm problems, heart disease and chronic diarrhea, he had only a flip phone and had no access to the Internet. We were able to put him in touch with a cardiologist and a home rhythm monitor identified abnormal untreated heart rhythms, which we addressed later.
For the poor and disadvantaged, lack of access to digital devices and the Internet is a major barrier to accessing telemedicine. It is important for health care providers to be aware of the social determinants of health and to identify barriers when screening patients. And if you’re a patient, you may need to ask staff or your doctor to help you navigate this changing digital health world.
Lack of physical examination can affect accurate decision-making
Eric, twenty-eight, was struggling with an earache that had become so severe that he was in pain now. During a video call, it was not possible to determine if he had a blocked ear canal due to wax or an ear infection. The two conditions may present themselves in a similar way, but are treated with very different approaches. In this case, a personal visit was essential. An examination of the ear showed an affected earwax. A simple irrigation of the ear helped to alleviate its symptoms, thus avoiding unnecessary antibiotics.
A role in recovery – at least for those who have access to it
Patricia, a 59-year-old woman, suffered a stroke that affected her mobility and vision, and is recovering from a recent brain operation. After leaving the hospital, she lived alone with little family support. A friend who was also her health care representative was present during appointments and helped her to communicate with her primary care team and specialists, using telemedicine through telephone calls or videoconferences. The friend also helped defend his needs. Her anxiety and insomnia were treated with medication and therapy through telehealth consultations. The care management team was able to put her in touch with other accommodation resources. Telehealth played a vital role in Patricia’s recovery.
Telemedicine is promising. However, it works best when primary care organizations and hospital systems fill the access and service gaps that inevitably occur.
Not sure if you’re using telemedicine?
Here are some helpful tips:
- Create an email address if you don’t already have one. This is the first step in helping you communicate with your doctor.
- Call your doctor’s office to find out more about how telemedicine works in their clinic. Staff can usually guide you through the steps to create an account and log in to the patient portal or health app you will be using.
- Familiarize yourself with the device you will be using (phone, tablet or computer) before your appointment. Ask a family member or friend for help if you need additional support.
- Ask questions and defend yourself. Telemedicine visits are new to many people, and it is normal not to know everything.
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