Hello #MedTwitter!

I've been thinking about how pervasive #telehealth is and will be in the future due to COVID-19. And especially (hi! have we met?) about how to prevent harm to disabled folx.

In classic @CPSolvers style, a schema that I'd LOVE feedback on!

Thread (1/16)

First, disclaimers.

There is far too little research on this
As an M2 #DocsWithDisabilities, I'm just trying to apply what I read to this unique situation
Most of all - EVERY situation is different
(2/16)

I think of this issue in two pieces - those factors which make disabled patients less likely to be seen by telehealth.

& those factors that must be considered during a visit. Let’s call it -ACCESS- and -EXPERIENCE-

How about we start with Access? (3/16)

There is a certain amount of panel management that must be done with telehealth. Who do you reach out to? Who do you feel the need to see? Who do you leave OFF your telehealth list?

All of these questions present opportunities for prejudice & ableism. (4/16)

IMPLICIT bias can make you think that because of someone’s ability level, they just “aren’t the right fit” for telehealth. Prevent this by checking in especially to your patients with disabilities or by choosing patients methodically. (5/16)

It’s also important, as with the rest of medicine, to really examine the accessibility of the software.
Does the EMR software support TTY?
Do you have translators or captioning as necessary?
Is there someone who can position and reposition the camera?
(6/16)

Accessibility is not just about the software, though. When having a visit virtually, safety can be much trickier than in a clinic.

Where are they for the visit? Are they alone?
How comfortable and safe are they in their space?
Are there obstacles on the floor? (7/16)

Nothing beats preparation -- find out what you can beforehand, tell patients they might need someone to spot them, and assess comfort at the beginning. (8/16)

Most importantly to the -ACCESS- half is knowing that telehealth is not immune to systemic disenfranchisement. Disabled pts, especially BIPOC or low SES, are less likely to receive quality care.

Let’s use telehealth to begin to alleviate that! #BlackDisabledLivesMatter
(9/16)

So we’ve made it this far! Let’s talk -EXPERIENCE-! (10/16)

Telehealth adds extra distance between you and your patients. It takes that much more effort to show your empathy, to connect, to relationship-build.

How about microaggressions?

What do you know about the patient’s disabilities beforehand? If you can’t see status of their LE -- don’t ask them to stand up!
ASK before assuming. (11/16)

Safety is not just to be assessed beforehand. Patients may feel they cannot say decline your request and thus put themselves at risk.

Assess comfort throughout. Make space for patients to say NO. (12/16)

We sadly also need to realize that many disabilities are invisible, even to HCW’s. Even if you're aware, you may not know how it presents or flares. (13/16)

Is there a cognitive load from auditory or visual processing?
Are pts struggling to take notes/remember?

How can you as a HCW alleviate this? We learned this in the first semester of M1 -- check for understanding, teach-back, etc. Or take notes TOGETHER during the visit!

Be creative! (14/16)

And finally, my most important thought for last. As with any patient contact, who are they connected to? Who else can you talk to? Who is going to be involved in care moving forward? (15/16)

It’s been quite a ride! Thank you for reading my thoughts. These are just my thoughts and I would love as many of the patients and ~real~ doctors out there to give me feedback as I continue to learn! #FOAMed #MedEd (16/16)