May 16, 2021. The Daily Reflector. By Anna Beth Robertson.
“Mr. Jones” showed up at our first virtual clinic not having seen a health care provider in nine months. He had been on the street since COVID-19 hit and recently found his way back to the homeless shelter. He had extremely high blood pressure and his prediabetic symptoms, anxiety and depression were all untreated. This is the story of many of our patients who were left without care during a time when they were most vulnerable.
Virtual visits, commonly known as telehealth, provide health care remotely via a phone or video appointment. Although telehealth has been around since the 1960s, it wasn’t until the pandemic hit that insurance companies lifted restrictions allowing this service to become more commonplace.
As an Albert Schweitzer Fellow and ECU Brody School of Medicine student, I have had the opportunity to serve people experiencing homelessness at our free student-run Greenville Community Shelter Clinic (GCSC). When the pandemic hit, public health guidelines forced us to suspend the clinic, which left many patients without care. Thanks to the support of our social worker and a donation of iPads, we were finally able to implement a model that used telehealth. After helping organize several virtual clinics, I would like to share some of what I’ve discovered about telehealth — the good, the bad and the ugly.
The good qualities are obvious. Telehealth can be used when transportation or geographic location are barriers to care. Individuals no longer need to miss work for appointments. Plus, they can get the care they need from the comfort of their home or other private setting while avoiding COVID exposure.
One of the challenges of telehealth is that it limits the ability of the provider to perform a physical exam. Some diagnoses such as a rash can be done over video. However, there are certain exams that can never be performed virtually. At one of our virtual clinics, we had a patient with an infected mouth abscess that was irritated and needed to be drained. The needed intervention could not be provided through the iPad, so the patient was referred to the Emergency Department in case of infection or complication.
The ugly side of telehealth is that the people most in need of health care, like those experiencing homelessness, do not have access to the technology needed to utilize it. I worry that the health disparities that have been made apparent by the pandemic will only be exacerbated by this new virtual reality. Additionally, many of the most vulnerable are those without health insurance who do not have access to telehealth coverage by Medicare or Medicaid.
Fortunately, we were able to get Mr. Jones his needed prescriptions to get his hypertension and pre-diabetes back on track. We referred him for mental health counseling and will continue to follow up with him virtually until we are able to safely have in-person appointments again.
As a result of this, I encourage health care organizations in Greenville and other cities to start thinking of ways that they can make telehealth more accessible for everyone. Public libraries or health departments could rent out rooms and provide tablets to community members for visits. Organizations can donate iPads or laptops to homeless shelters.
Providers and doctor’s offices should make it a point to ask patients if they have access to telemedicine and make accommodations if they don’t. Telehealth is here to stay. I believe it has changed the medical community for the better; however, we all need to do our part to make sure we are providing the access needed for care to everyone.
Anna Beth Robertson is a 2020-2021 N.C. Schweitzer Fellow and a medical student at the Brody School of Medicine at East Carolina University. She is from Elizabeth City.