EPtalk by Dr. Jayne 2/16/23

As we approach the end of the declared emergency surrounding the COVID pandemic, it will be important to assess how shifts in healthcare policies including those involving payment, access, and prescription medications will impact health outcomes.

A recent article in the American Journal of Obstetrics and Gynecology Maternal-Fetal Medicine looked at hos telehealth care impacted racial disparities in visit attendance during the pandemic. As background, the US has a terrible track record for maternal care, with maternal mortality rates that are significantly higher than other high-income countries. Additionally, in the US black woman are more likely to die during pregnancy and childbirth. During my time in the emergency department, the number of women I cared for who had no prenatal care was simply stunning given our time and place in history.

Researchers at Penn Medicine performed a retrospective cohort study looking at the issue by comparing data from 2020 to the same time period in 2019. Self-identified patient demographic breakdown included 63% black, 26% white, and 1% Latinx individuals. Prior to the addition of telehealth, black patients were less likely than others to attend a postpartum visit. They were also less likely to receive a postpartum depression screening or to breastfeed their infants.

After telehealth implementation, postpartum depression screening rates were equivalent, although black patients remained less likely to breastfeed. The authors concluded that “telehealth implementation for postpartum care during the COVID-19 pandemic was associated with decreased racial disparities in postpartum visit attendance” in a way that was statistically significant.

Numerous studies are demonstrating that telehealth can improve patient outcomes in the right situations. Especially for patient populations that may be marginalized, telehealth options can open the door to care that patients might not otherwise receive. Benefit can be derived from both video and audio-only telehealth visits, assuming the right protocols and safeguards are in place. In the short term, there are just some things that can’t be done without a face-to-face interaction, but as technology improves those gaps are narrowing.

I had dinner with some of my favorite smart women tonight and telehealth was a key topic, as were other non-traditional care delivery opportunities including school-based health clinics, mobile care units, and more. There are so many dedicated people in the healthcare arena who want to make sure patients get the care they need. Now it’s just a question of aligning the right priorities and incentives to make it happen. There are more than enough dollars being spent on healthcare, from insurance premiums to facility and provider bills, that we should be able to do better. We should be able to be better. The next few years will be interesting, indeed.

As someone who has been officially classified as a remote worker for more than 12 years, articles that talk about how remote work will be the death of business tend to catch my eye. The most recent one featured investor Marc Andreessen and his warnings that remote work isn’t good for younger people in the workforce. I got a kick out of the quotes where he called the office a “continuation of a college campus experience” and where he hinted that remote work has prevented not only the development of workplace relationships, but has stifled office romances. For any of us who has had to manage a team where romance may be in the air, I think we could do without the latter.

He also alleged that remote workers don’t have a sense of connection to their co-workers and that they don’t even know who their neighbors are. I’ve been with a fully-remote team for more than a year now, and I have to say that my relationships with some of my coworkers are as strong, if not stronger, than those with people who live in the same ZIP code.

In my experience, it’s more about putting the time in to understand who people really are and how they work best than it is about seeing them in person every day. It’s about setting shared goals and supporting each other, whether you’re 10 feet away or a thousand miles away. My co-workers are engaged outside the workplace whether they are younger, older, married, or single; whether they have families nearby, or whether they don’t. They take non-career-related classes to broaden their horizons, volunteer with various organizations, and travel. They find their sense of community through a mix of virtual and in-person interactions.

As someone who is older and I hope wiser in the workplace, I personally think that it’s healthy to shift the culture away from the idea that the workplace should be our social center. Wanting to have a life outside of work is a significant reason why many want to embrace remote work situations, where they can live where they like and have less time commuting and more time for other pursuits whether they be solitary or with others. I think some of us have forgotten the things that happened with in-office work that made people uncomfortable and that were difficult to get away from due to close quarters. We’ve all dealt with generally boorish behavior, people trashing the lunch room, unwanted smells, unwanted noise, and HR-worthy happenings at company parties and functions.

Although bad behavior can still happen in a remote environment, somehow it seems easier to tune out. If it gets to the point of needing to file a formal complaint, it’s more likely to be documented through email, chat logs, recorded meetings, and other media. Those “your word against mine” situations may look entirely different in a distributed workplace. I know I’m significantly more productive not working in an office, and that includes both work and non-work tasks. Given my penchant for throwing a delightful loaf of Three Cheese Semolina bread in the oven and timing it to be done just in time for dinner, I’m not sure I’d ever want to be in an office full time again.

What are your thoughts on remote work? Will it be the death of us, or should we not believe the hype? Leave a comment or email me.

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