NEWARK, NJ — By now, most people understand the protocol when it comes to meeting with someone outside their homes: You do it remotely, or you don’t do it at all.
But what if that someone is your doctor? In most instances, that, too, has adapted to the ways of the webcam to keep patients out of waiting rooms and safe in their homes. But in communities of color, where the coronavirus has gorged itself on already existing health disparities, telemedicine isn’t as simple as picking up the phone.
New Jersey Department of Health Commissioner Judy Persichilli shared earlier this month that the state is leaning on the expertise of the New Jersey Medical Association, a state chapter of the oldest national organization representing black physicians. Senator Ron Rice (D-Essex) and Assemblywoman Shavonda Sumter are also working with the group to better understand the issues both the medical community and patients are facing during COVID-19.
“The members of the association are basically trying to rely on telehealth in their urban environments and shared with us how difficult that is. They support more testing in community clinics,” Persichilli said during an April 18 briefing. “They called out the FQHCs as areas that we should be focusing. And they talked about the importance of staying at home and social distancing, but that in some domiciles, that's very difficult to do.”
Damali Campbell-Oparaji, an OB-GYN, assistant professor at Rutgers New Jersey Medical School and president of NJMA, said it’s critical for organizations like hers to be brought to the table with legislators.
“In addition to being strong leaders, we’re good listeners and good learners. Sometimes you can learn a lesson by looking at the mistakes others make,” she said. “For us in the medical community, some of it is learning lessons from places that have already gone through (COVID-19). If we’re already working together, then we can share ideas, so we’re not trying to reinvent the wheel. As legislators, they need to hear from the experts on these medical issues from a health perspective.”
At University Hospital, which launched its telehealth program soon after the lockdown, the mad dash to set up specialists with systems to see their patients remotely took time, even with the resources of a large institution. So, for smaller practices, the financial investment of devices, figuring out whether insurers cover telemedicine and how to bill for it, as well as all the other losses small businesses are accruing during the pandemic is making it harder for some physicians to provide care to their patients.
This is especially true in cities like Newark, where one in three homes don’t have internet access and many residents may be suspending phone plans as they join some 30 million Americans facing unemployment due to the public health crisis.
“We’ll probably see some problems with that as the months go on because people’s resources will be more and more strained as the months go on. When dealing with older clients who are not as familiar, it also poses challenges,” Campbell-Oparaji said.
No-show rates are also on the rise, she said, as patients’ fear of going into a doctor’s office or hospital increases.
While she said no-show rates tend to be high for gynecological appointments in urban settings, she’s seen above a 40% increase in her pregnant patients not coming in. They’re also asking about home births and expressing fear about delivering in the hospital.
Peggy Bodison, a Newark resident and cancer survivor currently on disability, said she has had mostly positive experiences with telemedicine so far, but said patients’ previous relationships with their doctors can make or break its effectiveness.
“I'm a diabetic and a cancer survivor and really do not want to take any chances of coming in contact with COVID-19,” she said. I'm fine with the telehealth program concerning PCP appointments if you have a close doctor/patient relationship. I'm on the fence with the psychiatric aspects of telehealth.”