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The concordance conundrum: the tech divide

COVID-19 resulted in the rapid adoption of virtual consultations; while they offer increased accessibility and convenience for some, are they really all they are cracked up to be? Consultations in a virtual world explores the pros and cons of virtual consultations and the responsibilities that the private sector and tech community should address with regards to ensuring that the poorest and most vulnerable in society don’t get forgotten or left behind in a seemingly more digital world.

“Hello? Can you hear me? I think you are on mute” – how many times have we all heard this over the past five or so months? Not exactly the perfect start to a meeting but nevertheless one we’ve all had to get used to when communicating from our home hubs.

From brainstorming with colleagues to after-work ‘drinks’ and families quizzes, for months now for many of us our lives have been remote with the only real change of scene on offer being which platform we were using or the room we are sitting in.

While not always being able to hear a member of your family clearly on a video call could be something of a blessing – let’s face it three months in, most things virtual began to lose their lustre – the same cannot be said for an appointment with a healthcare professional (HCP). Yet, unable or unwilling to leave our homes, digital communication technologies became (and will remain) an essential lifeline in terms of communicating with HCPs.

Prior to the arrival of COVID-19 even telemedicine had failed to gain real traction and uptake was sluggish – the year-on-year statistics are proof. In the US, the proportion of people using telemedicine rose from 11% in 2019 to 46% in April 2020, as face-to-face healthcare visits were cancelled.

The pandemic has accelerated our technological advancement in health beyond telemedicine to virtual consultations. Adoption has been fast, leaving everyone in healthcare, especially patients, grappling with the ‘new normal’.

For many, this has been a long time coming, after all we have had the technical capability for decades, but without the desire to revolutionise tried and trusted methods of HCP-patient communication, widespread use has been something of a pipe dream.

While virtual consultations were very much born out of necessity rather than desire, they are likely to be retained, even if only as means of triaging ahead of a more traditional face-to-face appointment.

Yet, fundamental questions will need to be answered before health systems go all out to embrace virtual or remote telemedicine. Can these technologies deliver healthcare more effectively – and cost-effectively? Can they improve health outcomes? And, crucially, how does virtual interaction affect the HCP-patient relationship?

Pros and cons

“Telemedicine can make it easier, faster, and safer to get the healthcare you and your family need,” says Rachel Bishop, medical director of Houston Methodist Virtual Urgent Care in Texas. “Wait times are shorter than most in-person medical visits. You don’t have to take time off from work or find childcare. And virtual visits can reduce your exposure to viruses and other infections.”

Convenience is clearly an advantage, removing geographical limitations opens up a world of opportunities. Patient choice of HCP could expand significantly, enabling people to seek out a particular specialist more easily. There is even some emerging (albeit anecdotal) evidence that patients who are anxious or embarrassed about a health issue may be more inclined to seek help if the interaction is remote.

One potential downside to remote or virtual interaction seems self-evident – that without true face-to-face contact between HCPs and patients, the human aspect is lost. The HCP cannot perform a physical examination, they may miss those subtle signs in both verbal and non-verbal communications, they may not be able to satisfactorily establish rapport or reassure/comfort those in their care.

There are other concerns too ranging from privacy and confidentiality issues to the inevitable technology glitches and usability concerns, especially for elderly people, those with physical and/or learning disabilities or those who simply do not have access to technology.

The great divide

Behind the potential that this technology offers lays a harsh reality. As the secretary-general of the United Nations, Antonio Guterres, recently pointed out, such technology “is threatening to become the new face of inequality”.

As we recover and rebuild from the pandemic, those without access will be left further behind, he says, adding that, while 87% of people in richer countries had access to the internet, this was only 19% in the least developed countries.

What’s more, he says, such inequality reinforces “the social and economic disadvantages suffered by women and girls, people with disabilities and minorities of all kinds. We cannot reap the full benefits of the digital age without mobilising global cooperation to close digital gaps and reduce potential harms”.

Mind the gap

To counter the many concerns around health inequality stemming from these communications technologies, Guterres suggests creating a “Road Map for Digital Cooperation”, which outlines steps that member states, the private sector and the tech community can take to close the divide between the richest and poorest countries.

It is clear that there is a balance to be struck; access is one concern and comfort level is another – not everyone, regardless of age, may want to engage with their HCP virtually. Just as video did not kill the radio star, nor should virtual consultations sound the death knell for face-to-face appointments.

Find out more

Consultations in a virtual world is one in a series of articles that look at how the healthcare landscape has changes in 2020 and how we need to adapt our communication techniques in order to thrive in an increasingly virtual world.

To find out more and to download other guides from the series, visit https://pageandpage.uk.com/media_lab

28th September 2020

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