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The good, the bad and the awkward of the e-health revolution

A few months back, a couple I know were struggling with their seven-year-old son. I’ll call him Ben to protect his privacy. Ben was reading below grade level. He couldn’t sleep on his own. He was struggling to ride a bike, and when his parents tried to help him, he would explode with rage and frustration. Covid, of course, compounded things—cut off from friends and family and ill-equipped for online school, he became overwhelmingly anxious and depressed. As Ben’s problems got worse, his parents sought professional medical help.

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At the height of the pandemic, such help was only available online. Ben’s dad was reluctant to go that route. Ben hadn’t taken well to virtual school, and besides, did he need more screen time? More importantly, didn’t a therapist or a psychiatrist need to meet the patient in person to really help him? Couldn’t his personality and specific struggles only be assessed IRL? But Ben’s mom insisted—their son was miserable, and something was better than nothing.

Much better than nothing, it turned out. During several online sessions, Ben received cognitive behavioural therapy. He was eventually diagnosed with ADHD and an anxiety disorder. Soon, thanks to the CBT and medication, he was sleeping by himself, his reading had improved, and he was accompanying his parents on long bike rides. After months of online therapy, neither Ben nor his parents have ever met the doctors who helped them in person.

Ben was hardly alone. By the time schools closed, lockdown measures had made in-person visits almost impossible; virtual care was pretty much the only kind of non-emergency medical care available to Canadians. Near the end of the first wave, in June of 2020, a Canadian Medical Association survey reported that about half the country had received remote care from a physician, and 91 per cent of those recipients were satisfied with the experience. I know of cancer survivors who were able to do their annual check-ins online; people who were correctly diagnosed, after emailing in a couple of photos, with rosacea or eczema; someone with schizo-affective disorder who was reassessed over videoconference and able to change up their meds.

I myself switched family doctors during the pandemic, from an old-school physician who didn’t do video to a younger one whose digital systems run with military precision. Our last virtual appointment, to address a back-pain flare-up, was successfully completed in five minutes. Just as Covid compelled all of us to become experts at shopping online, hosting Zoom parties and navigating various streaming services, we also learned—for better and worse—to become good virtual patients.


By the end of the first wave of Covid, about half the country had received remote care from a physician

 

Virtual care has been available in Canada since the ’70s, when a Newfoundland doctor named Arthur Maxwell House began providing consultations by phone. It was slow to spread: by 2014, only a minute fraction of billable services—0.15 per cent, to be precise—were conducted by teleconference. But within a few years, the technologies that enable virtual care became more sophisticated, more widespread—capable of upending the status quo and rendering many routine processes and procedures obsolete. Covid effectively nudged those services into the mainstream. Many clinics now offer virtual examinations for easy-to-diagnose conditions such as rashes and conjunctivitis. Digital technology has also enabled doctors to extend high-quality health care to remote areas of the country. Innovations in virtual reality and artificial intelligence have meanwhile enhanced and expanded treatment for dementia patients. And e-health comes with some pretty great perks: by one estimate, even pre-pandemic, in 2019, Canadians saved themselves 11.5 million hours and $595 million in travel costs by using virtual care.

The e-health revolution was catalyzed by Covid, and the speed with which it developed has understandably left us with some knotty problems. You can’t send hi-res images of a mysterious foot fungus, say, without high-speed internet—something still not readily available across the whole country. Privacy breaches are also a legitimate concern: those handy mobile health apps collect your personal data, and in some cases that data is shared with advertisers and third-party services (like Google). The spectre of two-tier health care also looms vividly over virtual care; it’s great that your neighbour can get an instant diagnosis via a medical app, but what if they can’t afford the app’s fees? We’ll need policy-makers to step in to ensure virtual care is as efficient, equitable and effective as possible.

And yet we don’t want the genie back in the bottle. Now that these newfangled tools are widely available, we can use them to improve the way health care is delivered. Who wants to wait six hours in the ER? No one. Who wants to schlep all the way to the doctor’s office, pay for parking and wait with a bunch of snorfling sick people in a waiting room if we can just turn on our computer at a designated time? There will always be people—particularly older patients—who prefer to see their physicians in the flesh. And there will always be conditions and ailments and lab work that require face-to-face meetings. But pandemic or not, health care can and should be a mix of in-person and online, in the same way that office work will likely be.

In the following pages, we take a deep dive into this new ecosystem. We look at how physicians can remotely monitor patients with chronic conditions, how labs can turn around test results more quickly, how decent mental health care can be accessed through apps like Inkblot, and how web services such as Maple connect patients with doctors instantly (while also helping health care workers pick up some additional cash). We’ve been preoccupied with one disease for a long time now, but all the other things that damage and threaten human lives haven’t gone away. To treat those medical problems as well as we can, we’re going to need every tool—old-school, newfangled, analog and digital—that we have.


This feature package appears in the September 2021 issue of Toronto Life magazine. To subscribe for just $29.95 a year, click here.

The good, the bad and the awkward of the e-health revolution