The house call has returned. Before the COVID-19 pandemic, something as simple as a bad cold required an in-person visit to my doctor’s office to get a prescription cough syrup. Now, the same office urges me to stay home and schedule a video visit instead. This new way of doing medicine certainly shouldn’t last forever across the board- there are only so many virtual visits one can make to a physical therapist before needing tactile intervention, for example. But the sudden shift to telemedicine did bring real help to Americans with life-altering chronic conditions. And we must fight to secure this unexpected progress before our healthcare system backslides to its pre-pandemic ways.
My ongoing battle with chronic migraine headaches began nine months before the COVID-19 surge in the United States, so I was one of the many “professional patients” who saw the scramble firsthand. Healthcare providers, seeking to balance affective care with public safety, had to decide how to practice in the pandemic- and quickly! Some of them, like my acupuncturist, jumped through countless hoops to continue in-person appointments. Others, like my headache neurologist, postponed all procedures and office visits in favor of video calls. This telemedicine approach doesn’t work for every type of visit to my headache clinic, as headache patients often need infusions and procedures like botox to cage the chronic pain monster. But the shift to telemedicine does improve one very critical aspect of chronic illness care: access to the specialists.
Access to basic medical care isn’t a problem for Americans, if they have insurance. But for people with chronic conditions who require specialty care, access is a huge problem, even with medical insurance. I waited for three months to see my headache neurologist for the first time, which meant ninety-two more days of constant pain because of my long-lasting migraine condition. And I was one of the lucky ones, because shortages in specialty care providers, such as headache neurologists, can be so extreme that it’s common to wait much longer or travel much further than I did to see a specialist. This is simply what happens when there are less than one sixth of the number of headache neurologists America needs. Similar shortages exist in rheumatology, neurology, pain medicine, and many other specialties.
But for many chronic illness patients, most visits to a specialist are consults and follow-ups, not procedures and physical examinations. There’s often nothing for a doctor to see, hear, or touch. And while I do prefer in-person consults with my headache neurologist, I certainly wouldn’t if I had to catch a flight or drive from another state to get to the clinic, or if I had to travel to a long-awaited appointment while battling a severe pain flare. So while telemedicine doesn’t address the shortage of medical specialists, for the patients who have to endure its consequences, it’s better than nothing. And for those who live very far from medical centers, it’s a godsend.
Improved chronic illness care is one of the pandemic’s most valuable accidents, and telemedicine is the unlikely hero of the story. But America is at risk of losing this progress as quickly as it came. The federal government has only temporarily waived Medicare restrictions on telemedicine, and private insurers have likewise avoided making their expansions to telemedicine coverage permanent. The initial rush to expand access leaves telemedicine propped up by temporary emergency policies, not long-term supportive structures.
When the pandemic ends, what will become of the video visit? Its disappearance would be an inconvenience for someone with a cold, who will again need to leave the house for a prescription cough medicine. But for chronic illness patients, the contraction of telemedicine coverage would be a disastrous regression in care. So let’s advocate for the permanent expansion of telemedicine coverage: petition legislators, contact insurance companies, and invite healthcare professionals to join the cause. Because for people like me, access to a house call is more than a novelty or minor convenience. It’s an open door that provides hope in the battle against chronic illness.