Virtual care can make all the difference when treating the most vulnerable patients

Beyond the pandemic, we need to ensure virtual medicine remains a permanent fixture of health care system.

A pediatrician takes part in a telemedicine call with a patient over a secure video connection. While it isn’t perfect, the use of virtual technology for some types of doctor visits can be revolutionary for children and their families, says Dr. Lester Liao. CBC Lucas Jackson, Reuters

Lester Liao, CBC News Opinion August 06, 2020

This column is an opinion by Dr. Lester Liao, a pediatric fellow at Sick Kids Hospital and a medical humanities scholar. He is also the director of Common Pursuits, an organization/publication fostering community through culture and neighbourhood living. For more information about CBC’s Opinion section, please see the FAQ.

As physician clinics begin to re-open, we need to ensure virtual medicine remains a permanent fixture in our health care system – particularly for young patients with special needs.

Prior to the pandemic, virtual care through videoconferencing instead of face-to-face visits with a doctor comprised a small portion of patient assessments. Barriers to development have included regulatory problems and old policies that fail to address virtual matters, security concerns, a lack of compensation mechanisms, and issues surrounding digital infrastructure. But COVID-19 isolation measures have spurred the adoption of virtual assessments out of necessity.

While virtual care is unlikely to entirely disappear after the pandemic given additional funding recently added by the federal government, its role remains unclear as the Canadian system continues to adapt to the new environment.

While it isn’t perfect, virtual medicine is revolutionary for some of our most vulnerable kids. A hospital or clinic can be a scary place, and from the tiny rooms to the funny looking instruments, these are not the most welcoming spaces. Even in pediatric offices, where walls are colourful and toys line the waiting room, a physician’s office is a strange space for many children.

When it comes to diagnosing and managing neurodevelopmental and behavioural issues for children, one of the most important things is understanding how a child functions in her own environment.

This is practically impossible in the doctor’s office setting, but virtual measures offer a window into a child’s most comfortable space. She can play with her toys more naturally, run around with less anxiety, and sing to her heart’s content while being assessed by a medical professional. The artificial setting evaporates, and this allows doctors to directly observe how children are at their best.

Approximately one in 66 children between the ages of 5 and 17 has this life-long neurodevelopmental disorder. These children generally have difficulties with communication and social interactions, a tendency to repeat specific patterns of behaviour, alongside heightened sensory awareness.

For some children with autism, breaking a normal routine and entering a foreign space with novel stimuli is completely overwhelming. You may be familiar with the irritation of being in a room that is too loud. Imagine this sensation multiplied, and then add a waiting room with crying babies.

This is why pediatricians take extra measures to accommodate children with autism in their clinics. Appointments are booked with extra time, environmental factors like lighting are adjusted, and patients are brought in at times when there are fewer other children. Some patients will visit the office beforehand to provide familiarity prior to the day of their assessment. Specialized clinics even help children prepare for their visits to the hospital, particularly when they’ve had traumatic experiences before.

These things help, but they aren’t perfect. Many parents know how difficult it can be to get a child to do anything, let alone visit the pediatrician.

Virtual visits can alleviate this problem. And the benefits extend to countless children with other difficulties that preclude a smooth experience in the office setting.

There are other advantages, too, that apply to any family.

A perennial problem for many families is the difficulty of transportation, travel time and parking costs involved when attending specialized clinics that may only be available at the children’s hospital downtown or in another community entirely. Treatment plans are reviewed, but sometimes parents are preoccupied with thoughts about the parking metre running out or the long drive home. Children can be particularly cranky after sitting in the car for hours on a trip to see the doctor, and this makes assessments challenging. And between the appointment and travel, the day is gone and a child already struggling in school will have yet more to catch up on.

Canada is also expansive, and we have long had difficulties with providing accessible health care across our country. Now we have an opportunity to reduce some of the disparities experienced by the most vulnerable in our society. Through virtual medicine, we can help kids no matter where they live, and save Canadians time and money by reducing travel costs and minimizing time off work.

Of course, virtual medicine has limits.

Many children need to be physically assessed and monitored, and in-person engagement is also critical to fostering a strong patient-physician relationship for the long term. Completely replacing clinic visits with virtual sessions isn’t feasible or wise.

However, particularly for children with special needs, the flexibility of virtual visits to a physician or specialist affords families another option, a stepping-stone that will help these young people get the help they need to thrive in society.

We need to improve our virtual networks to maximize accessibility, reliability, and security. Our health care policies and resources, from endorsing virtual care to adequately funding these assessments, should reflect this emphasis. The process may take time, but various physician bodies are beginning to seriously think about virtual care and its potential.

Our kids and our future depend on it.

About the author

Dr. Lester Liao is a pediatric fellow at Sick Kids Hospital and medical humanities scholar. He is also the director of Common Pursuits, an organization/publication fostering community through culture and neighbourhood living.

Source CBC News Opinion