By April 2020, I was ready for video. The Covid-19 crisis required that patients, clinicians, and staff stay home, so clinics throughout the United States had ramped up their telehealth practices. The federally qualified health center (FQHC) where I work had spent several weeks thoughtfully developing the workflows for video visits. I was eager to virtually see my patients — mostly elderly, Spanish-speaking, and low income — and be a part of the digital health revolution.
When I started, I thought there was a hierarchy in which in-person care was the gold standard, video visits were second, and telephone visits the method of last resort. But a year later, I don’t think of them as best, good, and OK. I see them as different — each ideal for different contexts. And just as people with visual impairment may have heightened use of their other senses, my year of telephone care during the Covid-19 pandemic has cultivated my capacity to connect with patients solely through sound.
It took only a day or two to discover the benefits of video communication. A patient called in to say he had run out of one of his pills. He lived alone and didn’t understand the labels on his pill bottles. Had he missed doses of his blood thinner or his vitamins? During our video visit, he showed me the empty bottle, and I was able to promptly identify the needed medication and arrange for home delivery.
But video was not the norm for my telehealth practice in 2020, for a simple reason: more often than not, it was problematic for my patients. Many of them had basic phone plans with restricted data for video calls. Others struggled to set up the video platform on their phone or to find a private space to speak openly with me about their health. We had set up the clinic to support video-conferencing technology, but the technology fell short of supporting patients with limited incomes, digital literacy, or housing.
The inequity in use of video technology for care during the Covid-19 pandemic is well documented: older, non-White, or uninsured patients were 40 to 60% less likely to use video visits than younger, White, or insured patients.1 It’s hard for patients to embrace digital health if their clinic does not have information-technology support or their clinicians don’t encourage them to try it. Aware of implicit bias, I told my patients about the public Wi-Fi program with outdoor access points on streetlight poles. I offered access to a language interpreter. I avoided reinforcing negative stereotypes in my notes (e.g., “patient declines video visit”). But despite such efforts, my patients were choosing telephone over video visits. I had to adapt and embrace this new reality. My patients needed to be heard.