Through all the changes that we experienced in the past two years, two trends became quite popular: staying home to binge-watch television and getting medical care over your phone. Interestingly, neither are new and both have been around for 20+ years in various forms. Both have become mainstream by the common denominator of COVID-19. This pandemic has allowed for many device-based conveniences to become top of mind, from Instacart and DoorDash to the endless proliferation of streaming services and telehealth companies. But are all these conveniences making it too easy to stop engaging the way we did pre-pandemic?
As life begins to return to something closer to normal and we enter the endemic stage of COVID-19, it's a great time to evaluate some lessons learned. I am 100% behind public health precautions including masking, social distancing, and vaccinations. But it is worth considering whether those that experienced, and continue to experience, anxiety, post-traumatic stress symptoms, and depression are having their symptoms exacerbated by isolation and now fluctuations in mandates. Are they being heard and seen? I worry they are not. The impact is clear, as noted in the Psychiatric Times in August 2021 reported:
"From August 2020 to February 2021, the CDC described an increase in the proportion of adults reporting recent symptoms of anxiety or depression from 36.4% to 41.5%, with the fraction reporting unmet mental health care needs increasing from 9.2% to 11.7%. Among children and adolescents, the proportion of mental health-related emergency department visits for those aged 5 to 11 years and 12 to 17 years increased 24% and 31%, respectively, compared with 2019."
There are so many reasons for this uptick - anxiety of getting sick, concern over supply shortages, fear of injection, future surges of the virus, and of course the loss of loved ones. Considering these, is telehealth alone enough for everyone all the time? I am not sure it is. I think the overall move from engagement with a clinician in-person to engaging with our phones is a huge reason for these increased numbers. We are missing subtle clues that our population is hurting; they are lonely and are not reaching out for the help they need.
In the summer of 2020, I was worried about my son being anxious about school during the pandemic and I decided to use a telehealth service. As a 15-year-old at the time, I figured that he would surely tell a stranger what he was feeling rather than me and doing it on his phone might be even more appealing than in real life. It did not go well. He hated it and I cut the service after the third session. I can't say he would have done better with an in-person therapist, but I do know that he felt zero engagement with a virtual one.
He is likely not alone. According to a recent survey, more than one-third of respondents said they'd had a video visit with a healthcare provider during the pandemic. While this may not sound astronomically large, it is three times as many as in a 2018 version of the survey. But roughly one-quarter of respondents who didn't use telehealth-likely equating to tens of millions of Americans-said it was due to feeling uncomfortable or that it wouldn't suit their needs.
Just like some big-budget blockbusters and other films are not exactly made to sit at home and watch on a laptop, not every healthcare experience is an ideal fit for the virtual world - however logistically convenient it may be.
To be clear - as a physician, I firmly believe that universally increasing access, and specifically bringing healthcare to those in rural areas-even internationally-is vital. According to a 2017 article from the World Health Organization, at least half of the world's population "cannot obtain essential health services." This is unacceptable. Telemedicine or virtual care is a great way to bring medical services to these populations, especially the ability to access specialists who may not be anywhere in driving distance to smaller villages and towns.
So where does that leave us?
2022 is well underway and we are still unclear of exactly where this virus is headed and what the lasting impact it will have had on all of us. We have self-driving cars, drones delivering food, and most of us spend our entire day on video calls, and the rest on social media. Who knows what innovations will emerge next year (or, to be cynical, the next pandemic). I am all for the conveniences offered to us by innovation and forward-thinking companies, but I hope we can come to an understanding that a "one size fits all" approach to healthcare should be a non-starter.
While it may work for some people in some situations, trying to make every aspect of healthcare as virtual as possible will likely lead to disillusionment, uncertainty or indifference - not things anyone should experience when discussing their healthcare. And to put aside all technical or logistical concerns, some people just appreciate the importance of touch and connection.
It is, as they say, what makes us human.