The Role of Telemedicine in Alleviating Healthcare Disparities in Under-resourced Communities

Around January 2021, I noticed something was wrong with me: shortness of breath and heart palpitations. Immediately, I thought I had heart problems, I contracted COVID-19, or I already had COVID-19 and now I’m experiencing post-COVID-19 side-effects. After all, reading those WebMD and CDC articles day and night consistently has got to make me paranoid. Either way, with concern for my health, I booked an appointment with my pediatrician the next weekend and was prepared for the worst.

What I didn’t expect was her to brush it all off like it was nothing. “You’re probably stressed. Just relax more.” I remember staring at my doctor in shock as I repeated my symptoms, careful to emphasize every detail. There was no way I believed her assertion without any bloodwork or medical tests. Worse, she spent more time prescribing vitamins for me than listening and then ushered both my mom and I out of the room before the ten minute mark hit.

Wow.

I was terribly frustrated. My doctor didn’t seem to understand my health concerns. In fact, she seemed impatient that I was taking up her time, when in reality, I was the one who wasted an hour driving and two hours waiting only to get a dissatisfied diagnosis. At that point, I lost what little trust I had in my pediatrician.

So I turned to Babylon, a telemedicine app, in hopes of filling the gaps my doctor left behind. To be honest, I didn't have high hopes. However, after a few meetings with my virtual doctor, I felt more empowered and confident than ever in consulting about my health and wellbeing. It was the first time I enjoyed a doctor’s visit and understood what it meant to feel like I had a doctor on my side. After my virtual doctor listened to me describe my symptoms, she immediately ordered blood tests for me to complete and explained to me what each result meant on the lab report. Luckily, nothing was wrong with me, and I never contracted COVID-19, but I was still hesitant and fired a million questions at her to confirm her assertion. And when she answered every single one happily, I knew telehealth was my saving grace. My encounter with telehealth reignited my trust in doctors and the possibilities of quality healthcare for low-income families like mine.

So while telehealth is not a definite substitute for in-person doctor visits, I think it’s important to acknowledge the growing presence of telehealth for under-resourced families that need a trustworthy and convenient healthcare service, especially one that “may save lost time at home or work, travel time, and missed and rescheduled appointments,” as stated in the Massachusetts General Hospital Study. This is especially important for low-income families that cannot afford days off from work for doctor visits and end up delaying a much needed check-up. According to Schwamm in healthitanswers.net, “With a telehealth visit, 95 percent of the time spent by the patient is face-to-face with the doctor, compared to less than 20 percent of a traditional visit, in which most time is spent traveling and waiting.” So not only are telehealth services convenient, they might prove to be more satisfying and efficient than in-person visits. To top it off, interpreters are available for most telehealth visits, virtual doctors can prescribe medications and send them to the patient’s local pharmacy for pick-up, and patients have the power to easily switch doctors if they’re not comfortable with them. Looking back, it seems to solve most problems low-income, under-resourced communities face in healthcare: convenience, efficiency and overcoming the language barrier—a close-to-perfect solution.

But does this necessarily mean telehealth alleviates healthcare disparities in all low-income, under-resourced communities? According to a Telemedicine and Healthcare Disparities journal article, it is not so simple. Moving to a digital platform has its downsides, especially for families that lack good internet connection, digital devices, and technology literacy. This is ultimately tied to socioeconomic status and the “institutional racism and ageism” in our healthcare system, which is revealed through minority communities being hit the hardest during the pandemic (Chunara and Zhao). There is also a lack of ethnic diversity and representation in virtual doctors. Often with white doctors, BIPOC communities don’t feel comfortable consulting about themselves, and there are implicit biases. Whereas with a BIPOC doctor, there is evidently more empathy and effort for minorities. As seen in a University of Michigan Health Lab article, “[When] A Stanford University study paired black men in Oakland, Calif., with either black or non-black doctors [it was shown that] black physicians were more likely to engage with them [their black patients], and even consent to preventive services like cardiovascular screenings and immunizations. And, the study found that black doctors were more inclined to write detailed notes about their black patients.” So it’s reasonable to infer that “similar representativeness among telemedicine providers would improve the telemedicine experience for diverse patients, reduce disparities, and improve health outcomes.” (Chunara and Zhao) Finally, there is the lack of the physical examination aspect in telehealth services. While patients can get referrals to get checked out in a doctor’s lab and then discuss their results virtually, it may not be a good long-term solution if their doctors cannot physically “meet” them through an in-person visit.

So overall, while there are setbacks to telehealth currently for under-resourced, minority communities, there are numerous benefits that address healthcare inequalities that families like mine face. With the evolution of telehealth in the near future, I’m sure these problems will be addressed, and with the power of technology, maybe virtual consulting will overtake traditional visits. Even so, I hope the expansion of telehealth also encourages traditional doctors to identify and solve the prominent issues with patient dissatisfaction and sprouts more creative ideas for bridging those gaps. An integration of technology to improve traditional doctor visits would truly bring the best of both worlds—and it’s exactly what AccessiHealth is aiming for.

In the meantime, I’d suggest anyone reading this to try telehealth in conjunction with your traditional doctor. Who knows, maybe you’ll find yourself in love with sitting on the couch as you chat away with your virtual doctor.

Citations

Donelan, Karen, and Esteban A. Barreto. “Patient and Clinician Experiences With Telehealth for Patient Follow-up Care.” The American Journal of Managed Care, vol. 25, no. 1, 2019, p. 9. The American Journal of Managed Care, https://www.ajmc.com/view/patient-and-clinician-experiences-with-telehealth-for-patient-followup-care. Accessed 19 March 2021.

Barthelemy, Joel. “Telemedicine vs. In-Person Visits: Which is Higher Quality?” HealthItAnswers, 29 July 2019, https://www.healthitanswers.net/telemedicine-vs-in-person-visits-which-is-higher-quality-2/. Accessed 19 March 2021.

Chunara, Rumi, and Yuan Zhao. “Telemedicine and healthcare disparities: a cohort study in a large healthcare system in New York City during COVID-19.” Journal of the American Medical Informatics Association, vol. 28, no. 1, 2020, p. 9. NCBI, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7499631/. Accessed 19 March 2021.

https://labblog.uofmhealth.org/rounds/minority-patients-benefit-from-having-minority-doctors-but-thats-a-hard-match-to-ma0ke-