The potential of telemedicine to affect a seismic shift in the delivery of care is now well proven. As the practice brings more and more medical specialties into its fold, we’re simultaneously seeing more innovation and technology take center-stage.
However, an aspect of telemedicine that still needs more conversations – and solutions – is the inherent gender disparity, for both, care providers and for patients.
When we began speaking to doctors and patients about their experience with telemedicine, a surprising discovery came to the forefront with women. We found that, instead of making things easier, telemedicine was actually getting in the way.
As far as doctors were concerned, remote access to their patients and appointments actually added more pressure to their workday.
“When I was meeting patients in my clinic, I had a defined place and time for taking appointments,” says Dr. Meenakshi Thakur, a practising GP in Tosh, Himachal Pradesh. Tosh is a little village in the Himachal valley and is about as remote as any mountain region might be.
“Although we’re fairly remote, we do have reliable wifi connections. So, initially the promise of telemedicine was very exciting” she says. “I was able to expand my practice to reach patients in Delhi and Chandigarh. But that access threw me fully off balance.”
Hidden Pressures for Doctors
The reality of the Indian subcontinent is that women handle a disproportionately high number of domestic tasks, regardless of their profession. While the advent and growth of telemedicine has made consultations easier for many doctors, women have found themselves with one more significant task on their list that needs to be managed – along with their work at home.
“All of a sudden I had patient calls coming in from 10:00 am to 10:00 p.m. I also have two little kids and unreliable help at home. So there were days when I was fielding patient calls, managing my home, and running after my kids, usually all together,” she says. “Unfortunately, the telemedicine practice hasn’t yet found a solution for creating a balanced life – at least not for me.”
Dr. Thakur’s experience is not an isolated one.
According to research released by JCO Global Oncology, “as the COVID-19 pandemic and the lockdown measures threw newer challenges, more women physicians than men (81% v 63%) shouldered the burden of increased domestic work and childcare.”
This disparity creates an unfavourable impact on all aspects of life, especially medical practice. In extreme cases, the increase in domestic responsibilities – because of a remote practice – has led to shorter working hours or forced quitting from work. The economic impact here is self-evident.
Dr. Thakur also pointed out the disadvantage that came with a day full of screen exposure. “We’re not just taking appointments online – we’re shifting all of our administrative work there as well.”
Long appointments are followed by administrative work such as recording patient notes and prescriptions in the EMR. Moreover, doctors are also holding their CME (Continuing Medical Education) sessions online. All of these aspects added up mean long hours of isolation, staying indoors, and in many cases, mental health issues compounding over a length of time.
“Doctors are not immune to the effects of long screen times and isolation, you know,” says Dr. Thakur. “We risk damage to our bodies and minds as well. And we’re also on the receiving end of social pressure – it’s not always easy to push back when the burden of household work and raising children continues to fall on us.”
The Flip Side
On the other side of the stethoscope, the challenges are different – but still significant, especially in India’s rural areas.
The most obvious challenge is access to care, but not for the usual reasons we suspect.
Research indicates that in rural areas women are less likely to own a mobile phone, as compared to men. Consequently, in a pandemic-driven world, where patients cannot always consult in person, we find that women in rural areas do not have the same access to care as men do.
According to a study published in BMC Health Services Research, “due to social, economic and cultural gaps, it is now evident that worldwide compared to men, women are 21% less likely to own a mobile phone.”
To begin with, women tend to hesitate when seeking medical care. However, the odds are stacked much higher against them if they don’t even have an available option to consider.
“So many of my patients in Tosh have come to me saying they weren’t aware of teleconsultations,” says Dr. Thakur. “When I asked them why, they said their families didn’t allow them to have mobile phones. So they didn’t even know they could get on a phone call to talk to their doctor, let alone a video consultation.”
Given societal conditions, there’s no surprise that gender shows up as a differentiating factor with delivery of care. But the situation can’t end at just a generic acceptance of facts as we look towards the future. Healthcare must bring everyone along.
“We’ll have to make conscious efforts to ensure we don’t always gloss over the challenges of any new technology” says Chiamala Aravamudhan, CEO at cSoft Technologies. “Yes, there are many benefits to telemedicine. But we can’t forget that the burden and access to care will need to be treated the same as gender equality. There are no easy solutions, but leaving people behind is not an option. As a society, we must collectively think of how to break the bias towards this issue of gender disparity in healthcare.”