Telehealth: A Lifeline For Marginalized People

If you had told me three or four years ago that I could “go to the doctor” from the comfort of my bed or couch, I would probably have laughed in your face. And then I would have told you that it’s a great idea—because as an overwhelmed twenty-something trying to juggle jobs, debt, health issues, bills, and all the rest… honestly? Cutting out the commute and wait times attached to a doctor’s visit would make it that much more likely that I would actually… go to the doctor.

The thing is, going to the doctor from your couch, or “telehealth”, has actually become super common. When COVID lockdowns and social distancing requirements came down, the healthcare sector spun up telehealth services at high speed and volume to ensure that people could get their blood pressure medication, their prenatal counseling—and yup, even their birth control—from the safety, privacy, and comfort of their own homes. And just like wearing sweatpants to work or seemingly endless Netflix dating shows, telehealth is one of the changes brought on by the COVID-19 pandemic that seems to be here to stay, with more and more people reporting that they prefer telehealth over in-person visits. In fact, telehealth use amongst the general population is 38 times higher now than it was pre-COVID. In conversations with friends, I’ve learned that many of my peers now prefer telehealth for routine appointments—like therapy or counseling—because it makes it that much easier (read: actually possible) to be consistent and fit health needs into hectic day-to-day schedules.

The reality is, though, that while telehealth has become widely popular for the convenience factor—for a lot of people, it’s a lifeline and the only way they can access healthcare. It’s important to name that disability rights activists were fighting for accessible telehealth long before the pandemic forced the health system into ramping up this type of care. That telehealth now benefits everyone is a great example of the “curb cut effect”: in the same way that adding “cuts” to sidewalk curbs for wheelchair access made it easier for everyone to navigate the sidewalk with strollers, bikes, and the like—telehealth appointments, and increased accessibility for disabled people in our health system, benefit everyone and society at large.

Here are some of the reasons that telehealth appointments—and making sure they truly are accessible—are so important:

1.       Time. For a lot of people, taking time off work is just not an option. And setting up childcare or elder care can make it even harder to finagle a few hours out of a workday. Setting up a birth control appointment via telehealth completely cuts out commute time to and from the health center—in addition to time spent in a health center’s waiting room. We know that immigrants, women, and people of color disproportionately work jobs that do not give them the flexibility to take time off work. If you just do not have the time to commute to the health center for your birth control, then telehealth might be a great option for you.

2.       Privacy concerns. This is particularly relevant for young people or people experiencing or at risk of domestic violence. If you’re worried about privacy and feel like making a trip to the health center may be a risk for you—or if you’re too young to drive or don’t have public transport options—telehealth can give you the option of getting your birth control care from a safe place. The same privacy and confidentiality rules that apply to in-person visits also apply to telehealth. The clinician should state “HIPAA laws require that I conduct the telehealth appointment with no one else present.” If you or someone you know is at risk of domestic violence, help is available. Call the National Domestic Violence Hotline 800-799-7233. Hours: 24/7. Languages: English, Spanish and 200+ through interpretation service.

3.       Accessibility. We know that navigating the health care system is hard for everyone—but it’s especially challenging for people with disabilities. And even though the ADA makes sure that all health centers are equipped to provide accessible care to all, sometimes it still isn’t enough.  A telehealth visit allows for critical, additional support that people with disabilities often require. For one thing, telehealth appointments can ease the burden and loss of time of having to find an interpreter by allowing a patient to have an already available friend, family member or established interpreter help them with their needs from the comfort of their home. For those who are hearing or vision-impaired, a patient can adjust settings on a mobile device to make it easier to see, hear, and receive a more comprehensive understanding of the information being shared, depending on whether the telehealth appointment is via phone or videoconference. For those who are mobility impaired, accommodations on public transit are often out of order, or are limited to one or two people per bus or train. This makes it difficult or expensive to commute to the health center, even if accommodations are in place at the site itself. Telehealth also widely benefits people with non-apparent disabilities, who are often shamed into forgoing the disability accommodations that exist in many public places. Again, if this is your situation—you can get care through a telehealth appointment. Make sure you let the health center know about your accommodation needs when you set up your appointment.

4.       Anxiety about the health center. For some people, particularly people of color, folks identifying as queer/gender-nonconforming, or people with disabilities, a visit to the health center can be triggering or anxiety-inducing—even if you know that you like and trust your doctor and are going in for care that you really, really need. If this sounds like you, first, know you’re not alone. Second, all ICAN! providers are trained in TRUER care: care that is Trauma-informed, Respectful, Unconscious-bias checked, Evidence-based, and Reproductive well-being centered. And third, telehealth could be a great option for you. Again, you can have your visit wherever you feel comfortable taking a call.

5.       You live too far away. Sometimes, it’s just that simple. Your one health center is far away, and you know they don’t have the birth control method you want. Again, you’re not alone—19 million women actually live in counties without reasonable access to all birth control methods. If this is you, telehealth is going to drastically increase the options that you have for care. You can even get birth control refills shipped to your door.

To wrap up—telehealth is just part of how we do things now. These ICAN! Quality Hub providers can set you up with a telehealth appointment to get your birth control of choice from the comfort of your own home. And remember—don’t forget to thank the people who fought to make this care accessible for those who need it most.

Authors: Michelle Johnson & Isha Datta