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A Black man has a telehealth appointment from his kitchen.

The other night, My Lovely Wife sat on the porch glumly considering her options for investigating a bothersome foot issue. Our trusted practitioner of Traditional Chinese Medicine has shuttered her clinic, so MLW was left to rummage through an online collection of local naturopaths, chiropractors, acupuncturists, and other miscellaneous purveyors of the healing arts. Conventional physicians, she noted, would simply look at her foot and refer her to someone who would be more than happy to cut it open. She prefers a more nuanced approach.

But when she located a naturopath we’d taken the kids to see years ago, she discovered he was only available for online consultations. “If I’m going to go to all the trouble of seeing a doctor, I’d like to at least be in the same room,” she noted. End of search.

The current pandemic has created a booming market for telemedicine, virtual doctor visits via Skype or Zoom or some other app I haven’t yet encountered that allows one-on-one conversations from the COVID-safe confines of your home. But, as you might suspect, geezers tend not to be early adopters of such innovations. Some, like MLW and me, can’t imagine cultivating a satisfactory doctor-patient relationship by talking to a screen (though we’d escape the meaningless blood-pressure test and the silly requirement that we stand on a scale), but for many of our elderly compatriots who depend on regular visits to their healthcare provider, the shift to online consultations presents a much more serious challenge.

“Telemedicine is not inherently accessible, and mandating its use leaves many older adults without access to their medical care,” says University of California–San Francisco geriatrician Kenneth Lam, MD. “We need further innovation in devices, services, and policy to make sure older adults are not left behind during this migration.”

Lam and his colleagues last week released the results of a study suggesting that more than a third of U.S. seniors — some 13 million — could find themselves struggling to connect with their physicians as the pandemic continues to limit in-person clinic visits. And, while low-income and rural folks report predictable computer and internet-accessibility challenges, the elderly on the whole struggle with myriad medical conditions that obstruct productive online communications.

Analyzing data on 4,525 patients from the 2018 National Health and Aging Trends Study, UCSF researchers concluded that 38 percent of elderly Americans — and 72 percent of those 85 and older — were not equipped to take full advantage of virtual doctor visits. Even among those study participants with access to a computer and internet, Lam and his team found a sizeable portion whose illnesses — including poor hearing and eyesight, speech difficulties, and dementia — would hinder an online consultation. Without the body-language cues of a face-to-face meeting, they noted, a good deal of valuable information would be lost in a screen-to-screen conversation.

“To build an accessible telemedicine system, we need actionable plans and contingencies to overcome the high prevalence of inexperience with technology and disability in the older population,” Lam explained. “This includes devices with better designed user interfaces to get connected, digital accommodations for hearing and visual impairments, services to train older adults in the use of devices and, for some clinicians, keeping their offices open during the pandemic.”

As is so often the case around here, MLW’s foot troubles appeared to have become less troublesome in the days since they first attracted her attention, and treatment strategies have gradually drifted into the ether, apparently replaced by a sudden desire to repot the houseplants. She did mention at one point that she might check in with a neighborhood massage therapist, who boasts little online presence and owns neither a blood-pressure gauge nor a scale, but there’s been no noticeable movement in that direction at this point.

I had actually forgotten all about it until we sat down yesterday for our afternoon coffee break. “So, how is your foot?” I inquired.

“It’s fine as long as I don’t think about it,” she replied. “So, thanks for reminding me.”

It’s moments like this, I suppose, that argue most persuasively for virtual consultations. On Zoom, I could’ve claimed a faulty internet connection (“Hello? Hello? I can’t hear you. You’re freezing up!”) and then surreptitiously quit the app. As this was real life, though, I simply sipped my coffee, waited for the moment to pass, and mentioned how lovely the houseplants looked.

Thoughts to share?

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