April 27, 2022, 9:13 a.m. Bhargavi Chekuri, M.D., and Meredith Milligan, M.D. — As women on the front lines of COVID-19, we can tell you: The pandemic has not been a good time for women. We’ve seen stark inequities. We’ve seen the worsening of gendered health gaps. We know that the pandemic has been linked to an alarming rise in intimate-partner violence, attacks on reproductive rights and financial hardship for women.
But we’ve also noted a rare bright spot during this dark moment: the expansion of telehealth. In fact, as family physicians, we have been among the first to use telehealth ubiquitously in clinical practice.
We became acutely aware of this change two years ago, when we began seeing patients during the first week of lockdown. As we ventured virtually into our patients’ homes, backyards, workplaces and cars to discuss everything from blood pressure and diabetes management to antidepressant therapy and alcohol use, we swiftly grasped the powerful role that telehealth could play in getting our patients what they needed. We also understood that this new ability to maintain and strengthen relationships with some of our most vulnerable patients was a priceless gift. For women, who still tend to shoulder the majority of caregiving responsibilities within their families, this has been especially true.
Take, for example, Lynne, a 36-year-old single mother of two who even before the pandemic struggled to make it to the majority of her primary care visits. For years she suffered from an untreated mood disorder, compounded by overwhelming caregiver stress. Balancing work, transportation and child care to make it to a clinic appointment on time was nearly impossible. Once telehealth became an option, though, Lynne and her children were able to connect with their primary care team on a routine basis. The whole family caught up on preventive care, and one of the children at last received the wrap-around, multidisciplinary care needed for longstanding developmental concerns. Lynne met with a psychiatrist and started counseling. She was also able to access reproductive health services, a further promotion of independence and personal agency afforded by telehealth access. Most important, her improved access to physicians and counselors helped build trust, leading to a dramatically better relationship with our clinic and the health care system in general.
There are so many other positive stories such as Lynne’s. But we need legislative and regulatory support for telehealth flexibility beyond the pandemic in order to assure that Lynne and countless other primary care patients continue to benefit from this opportunity.
The COVID-19 pandemic is only one part of the bigger story of how planetary health is changing, and how these changes continue to disproportionately affect the world’s women. Health disparities similar to those revealed by this public health emergency also result from climate change, which is happening now and will worsen over the next century. Frequent and intense heat waves, droughts, wildfires, storms and changing disease patterns will increase women’s risks of disease, poor mental health, malnutrition, violence, pregnancy complications and even death. It is exactly during these difficult times that women need increased access to their physicians, counselors and medical teams — which telehealth provides (while cutting down on greenhouse gas emissions and adding resiliency to our health care system).
Telehealth doesn’t increase women’s ability to get essential care only in times of crisis, though. It also promotes increased continuity with primary care teams for their children and families. Our own experiences these past two years have made clear just how essential telehealth can be in delivering affordable, accessible high-quality health care to Americans, especially women. Our broader care system can only benefit from robust telehealth access.
Federal and state governments should act now to strengthen existing telehealth infrastructure and make it easier for Americans to see their physicians. Permanent telehealth flexibility is an example of commonsense health policy and smart climate protection. By passing legislation that the AAFP supports, Congress can take immediate steps to help the fight global warming and improve American lives. On the heels of the IPCC’s sixth assessment report, COP26 and the increasingly hazardous climate-related disasters affecting the country, we should all sprint toward solutions such as this.
Bhargavi Chekuri, M.D., is a practicing family physician based in Denver and a National Climate and Health Science Policy Fellow at the University of Colorado School of Medicine.
Meredith Milligan, M.D., is a practicing family physician based in Concord, N.H., and a Leadership and Preventive Medicine Resident at Dartmouth-Hitchcock Medical Center.