CEO, medical division chief, vice president of the United States; decades of blood, sweat, and tears on the part of our female forebears have allowed women to achieve the elevated social status that, decades ago, would have been impossible. Despite progress toward economic equality, there is still a stigma that women have to overcome to be considered “equal” in the workforce.
As women continue to achieve leadership roles in the workforce, they are often met with full schedules and little time for self-care. As a result, these women need more opportunities to maintain a medical relationship with their clinicians and continue to advance in their careers without jeopardizing their achievements when requesting a midday doctor’s appointment.
As gynecologists, we advocate for our patients to actively participate in annual exams in an effort to prevent diseases, screen tactfully, and educate our patients. Despite the importance of maintaining a medical relationship with the women in our communities, the recent COVID-19 pandemic catalyzed the adoption of virtual care delivery across most medical specialties.
Things are slowly getting back to normal, and offices have reopened, so many practices have transitioned away from offering telehealth. I believe it is important to continue to provide telehealth for women’s gynecological visits to help cater to the women who otherwise may not have time, or individuals who may not have transportation. It is better to have more options for providing health care, and telehealth should continue to be used.
Though initially met with apprehension, telehealth has been extremely well-received by patients and practitioners alike. It offers many attractive benefits, including convenience, flexibility, and the option to bypass waiting room delays.
There are some visits that are inappropriate for virtual visits, and an in-person examination would be recommended. A simple office phone call could help determine if a visit would be better served as an office visit versus a telehealth visit. In our practice, there is a specific list of acceptable telehealth visits. Things like results review, imaging follow-up, a quick discussion about surgical plan, and counseling can all be done using a virtual platform.
An example to highlight the positive experience of telehealth was when I was working with a reproductive endocrinologist and infertility physician. A well-respected businesswoman who has worked for many years and delayed childbearing was able to have a 30-minute counseling meeting on reproductive options and infertility work-up. This allowed her to stay in her office and have an expectation of what her outpatient experience may be. With the counseling portion of the exam completed, she can know what to expect during her workup and avoided travel and waiting room delays.
Another patient who benefited from a telehealth visit was an elderly female who experienced post-menopausal bleeding and came to the office for a biopsy. The patient was worried about the pathology results but had transportation issues. She was able to be seen via a virtual visit and reassured with benign results.
With the video and virtual components, many postoperative wounds can be examined, pathology and lab results can be reviewed, and models can be used to explain pathologies without the patient needing to come to the office for a full physical exam.
In addition, other maintenance exam visits such as birth control, hormone replacement therapy, medication for overactive bladder, vaginal dryness, etc., can all be done with a quick telehealth discussion.
Though these types of encounters can supplement office visits, many aspects of gynecologic care do still require a patient to be seen in the office. We should be clear when offering virtual appointments that some points of care are much better served and evaluated in person. Some diagnostic and treatment protocols, including Pap smear and breast cancer screenings, require in-person appointments. Additionally, patients who are experiencing pain or postoperative complications should be seen in-office. In addition, a new patient, when establishing care, should be seen in person for a head-to-toe physical exam to establish a baseline. That way, if problems arise, they can refer to the initial exam for comparison during future encounters.
People are fearful that telehealth visits will result in missed diagnoses. I, however, believe that if people have an option to see a clinician that is more suitable for their busy lifestyle, it should be encouraged. The more we can reach a diverse number of people with busy lifestyles, the better we can continue to counsel and educate a larger patient population.
There will still be many patients who are comforted in going to a doctor’s office and seeing them face to face. These individuals will still be encouraged to show up for their office visits. But the same flexibility should exist for women who do not have the luxury of leaving their job, have limited access to appointments, or have challenges when arranging for childcare.
I see the future of telemedicine application in ob/gyn practices as a supplement, rather than a replacement, for in-person appointments. Virtual appointments offer an ideal opportunity to have one-on-one conversations about behavior and lifestyle modifications, psychosocial stress, and sexual health with patients who may have scheduling, family, and/or transportation obstacles to in-person appointments. The marriage of availability via telehealth and access to care without the inconvenience of disrupting one’s already busy schedule seems to be an excellent way to allow clincians and patients to connect. I truly believe that connection, in whatever capacity we can with our patients, will, in turn, improve the population's health.
As physicians, we must embrace innovation and offer all available options to help our patients prioritize their health and well-being. Telehealth in gynecology should be an option in most office practices.
How has telehealth impacted your specialty? Would you like to see it continue? Share your thoughts below.
Courtney Fox is a minimally invasive gynecology fellow and women’s health care advocate. She is passionate about making sure patients are educated on their bodies and understand their treatment options. You can follow her on Twitter @CourtneyFoxMD and Instagram @courtneyfoxmd.
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