Hannah Kim, PharmD ’20
HHS Competencies: Social and Structural Proficiency; Narrative and Historical Perspective
The spread of SARS-CoV-2 has left little of modern life untouched, and the healthcare system is certainly not an exception. As hospitals swelled with infected patients, healthcare providers turned to telehealth to provide care for their non-emergency patients.
The idea of home healthcare is not new, though the modality of 2020 telehealth is novel for its frequency. Telehealth refers to many services provided remotely, the most common of which is an online meeting on a conferencing platform such as Zoom. The switch from cold, clinical office visits to ones in the warmth of home is an abrupt one, albeit perhaps advantageous to more anxious patients, as Dr. Gregory Young of Longwood Pediatrics notes. It is “fun,” he describes, seeing his patients’ homes and pets, and the location helps his more timid patients open up and be more interactive with him. Telehealth’s implementation, it seems, is the boon that some advocates have hoped for, yet it is far from perfect. Like anything else, it fails to be a rich medium in its own ways.
As media richness theory describes, the “richness” of a medium—its ability to support total communication—can be measured by its ability to provide immediate feedback, its receptiveness to multiple forms of communication, and its personal focus. While at its core, telehealth retains much of an in-person visit’s integrity, what it loses is physical communication. The rapport between provider and patient is built upon both verbal and non-verbal communication, and is what ultimately allows the diagnostic and caregiving processes to provide a path forward—what they are supposed to do.
The check-up is largely concerned with quotidian life. It is easier to form a rich narrative surrounding what is familiar. The diagnostic process, however, is reliant heavily upon the analysis and dissection of evidence taken from anecdotes. These anecdotes are often inaccurate, not because the person’s narrative is false, but instead because the layperson will not always possess the same varied vocabulary to describe what is happening to them as a doctor who has trained for years to notice and analyze symptoms. Instead, the average person is forced to use their own limited vocabulary. The reality of, for example, a neurological disorder, is obscured first by the patient’s perception of the disorder’s effects, then by their constructed narrative. Should the patient have experience with neurological conditions, they may be able to construct a narrative which details their suffering in terms such as “fogginess,” “light-headedness,” and “jerky eye movement.” The average inexperienced person, however, will often default to language they are familiar with. Limited by their narrative capabilities, they may only be able to describe what is happening as “dizziness” or “feeling weird.” Thus, healthcare providers cannot rely on patients’ anecdotes alone; they must fill in the narrative weaknesses using physical examination. With telehealth, providers are unable to perform such examinations, and, therefore, turn to alternate methods, such as using video and photo evidence of range of motion tests. These alternate methods are just that—alternate, Young says. Methods such as pictures and photos are often dependent on internet access, and are often simply not a viable replacement for in-person examination.
These critiques, though valid, are not necessarily the fault of telehealth. Like any technology, telehealth is merely a tool that reshapes our lives. It is the shifting of the world around telehealth that illuminates the lurking structural inequalities. Poor broadband and internet access affect far too many communities, and even when access is not a problem, the internet is far from perfect. As life moves increasingly online, rural, poor, and disabled communities find themselves struggling to amplify their voices on a platform that is, at best, dismissive, and at worst, hostile.
The inability of patients to articulate themselves is perhaps the most worrying failure to be exposed at such a large scale. Disorders and diseases are frightening and can be isolating when a patient cannot be connected to the help that they need. These problems highlight the failure of education and narrative. For all that mental health and disability advocates have pushed for increased access and transparency in the medical world, patients are left to suffer two-fold: once from their symptoms and once from the confusion and isolation surrounding their status. What language can give us is hope: comprehension and communication. With a rich and varied medical vocabulary, patients are thus able to express and advocate for themselves in ways that are clear, concise, and painless. Without such language, patients are left to fight their way uphill to a diagnosis and treatment plan.
Telehealth is a double-edged sword: it is both a tool with which healthcare providers are able to connect with their patients throughout tumultuous times and a highlight reel of the ways the healthcare system can fail inexperienced patients. Neither telehealth nor the problems that it highlights are new, but its current widespread usage affords us the opportunity to set a new precedent with communication.
The crux of the telehealth problem is access. Access to open, easy communication is imperative for fostering a beneficial patient-provider relationship. That access must come in several forms. The access to high-speed internet and consistent quality of care, as well as access to medical language and concepts are integral to the wellbeing of any patient using telehealth.