Topic: As Telemedicine Surges, Will Community Health Suffer?

I’m an urgent care doctor. I see patients each week at a community health center in East Baltimore, a sturdy two-story brick building across from the Latrobe Homes housing projects, right next to the sprawling city jail complex. Our clinic was founded in the basement of the church across the street: a constructive community response to the chaos and unrest that swept through Baltimore and other major U.S. cities in the feverish days that followed the assassination of Martin Luther King, Jr. Like other clinics with origins in the late 1960s community health center movement, ours was planned as a place for building neighborhood health: primary care medicine, pediatrics, OB/GYN, a small laboratory, X-ray facilities, and a pharmacy. It was not built for a disaster like the current coronavirus pandemic. We have no negative-pressure rooms, no N95 respirators, no capacity even to perform COVID-19 testing.

When my patient showed up at the clinic door last week—let’s call him Guillermo—he was greeted by masked and gowned COVID-19 screeners, scanned for fever, and asked from a distance of six feet if he had recent symptoms of cough, runny nose, fever, or sore throat. Anyone who tested positive for any of these things would be sent back outside, called on their personal mobile phone by the screening physician for further conversation at extended distance, and sent to the emergency department for treatment if symptoms warranted. Most would be told simply to self-isolate and manage their condition at home with over the counter medicines. Since the State of Maryland had just days earlier banned all elective procedures and non-urgent visits, anyone looking to follow up with their primary care provider would also be sent back home to set up a telemedicine encounter using the software app established by our electronic medical record vendor. Guillermo was sent upstairs to see me.

As the growing surge of coronavirus cases begins to crash upon an underprepared U.S. hospital system, the everyday business of outpatient medicine has been upended as well. Essential services for managing chronic illnesses like diabetes, high blood pressure, congestive heart failure, and other serious conditions no longer take place in the examination rooms of clinics like mine, or even in the outpatient facilities of the Johns Hopkins Hospital just down the road. Instead all of these forms of care are suddenly and calamitously being pushed into telehealth: a medical media most health care workers have only limited experience with. Seemingly overnight, hundreds of thousands of outpatient doctors and nurses are being asked not only to record their patients’ histories in electronic medical record systems but to conduct the entirety of their clinical experience within this digital space. Millions of American patients are now encouraged to conduct medical visits via proprietary software packages installed on their computers, tablets, and smartphones. For those who can do so, this technological platform may well promise a new era in patient empowerment. But many others are wary that essential elements of care may not be carried through the new medium—that is, if telemedicine is available to them at all.

Topic Discussed: As Telemedicine Surges, Will Community Health Suffer?

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