Image courtesy of the Wall Street Journal, 2021

In a recent article in the Wall Street Journal, Dr. Ateev Malhotra and Barak Richman wrote about the “brutal” trip Maki Inada makes for her cancer treatment. For patients who live outside of a large metropolitan area, it can be extremely challenging to balance receiving cutting-edge treatment with maintaining their jobs and home life.

Maki Inada is juggling a lot these days. She’s a biology professor at upstate New York’s Ithaca College, where she balances teaching and research on messenger RNA (suddenly a topic of global interest). She is a mother of a vivacious 10-year-old who just finished fourth grade, and that means lots of driving back and forth to gymnastics and swimming practice. And she has lung cancer. In April, after years of clean scans, the cancer was back. She just had major surgery and is starting chemotherapy again. She has a lot of appointments with her local oncologist and her oncology team at the Dana-Farber Cancer Institute in Boston.

One silver lining of the pandemic for Ms. Inada was that she didn’t have to drive to Boston for her appointments. She began having video calls with her doctors and planned to conduct many of her postoperative and oncology appointments via telemedicine. But regulatory changes in the past month have thrown a wrench in those plans. Dana-Farber told Ms. Inada she’ll have to be physically located in Massachusetts for a visit. She doesn’t have to go all the way to the doctor’s office, a 5½-hour drive each way. She can drive 3½ hours, cross the border into Massachusetts, pull over, and have a telemedicine visit in the car.

So for her next appointment, the grandparents drove 11 hours to Ithaca to watch their granddaughter, and Ms. Inada and her husband drove to Boston. After she had some scans at the cancer hospital, she quickly had a telemedicine visit from the lobby. But she had to skip one of her postoperative appointments because you can only drive back and forth so many times.

This sudden, severe and senseless inconvenience results from one of the historical vestiges of U.S. healthcare. The practice of medicine is regulated by state medical boards, which can license doctors only to practice medicine in their state. Traditionally, medicine is “practiced” where the patient is located. If Ms. Inada is in New York during an appointment, then her physician must be licensed in New York even if he is somewhere else.

Ateev Mehrotra and Barak Richman

While Malhotra and Richman argue for state medical licensure reciprocity, there are still certain situations that require the patient to be seen in-person. This is where organizations such as Angel Flight and similar can become lifelines for patients.

Josh Flowers, of the YouTube channel Aviation101, joined one flight and shared his experience in the video below.

Inada makes good use of telehealth services to be seen by providers, despite the tedious drive she must make to the Massachusetts border for legal reasons. In fact, I’ve written about the value of telehealth in the WFCC Newsletter. I suggested that we reframe the discussion of telehealth from reducing costs to increasing access to care.

This year, we have seen radical shifts in the way that healthcare is delivered. Early on, the COVID pandemic forced many non-urgent medical visits to be cancelled, including at the free clinics, helping healthcare institutions reduce the strain on limited resources. Almost immediately, the WFCC embraced the idea of virtual visits by setting up a free telehealth program. This idea was born out of the need to continue treating patients who would otherwise be almost completely disenfranchised from the healthcare system. Their ailments and conditions did not simply disappear overnight. Instead, telehealth became a lifeline for the uninsured and underinsured population in central Massachusetts.

[. . .]

Prior to the COVID pandemic, telehealth was seen primarily as a method to reduce costs. However, for free medical programs, telehealth should instead be seen as a method to increase access to care. It erases geographic boundaries and allows patients to not worry about transportation or scheduling time off from work or from childcare responsibilities. Looking at telehealth technology through this lens leads to a mindset that encourages the build-out of necessary infrastructure to reach patients and break down barriers to healthcare for disenfranchised populations. It becomes easy to justify the need to invest resources in public facilities, such as keeping public libraries open for longer hours or providing dedicated equipment and tutorials in multiple languages.

[. . .]

Ultimately, telehealth is not a substitute for in-person visits. While the circumstances may force virtual visits to continue throughout the foreseeable future, it is not sustainable for all types of conditions. Some simply cannot be treated through telehealth. Healthcare institutions should determine where telehealth can be an effective way to help increase care, for example, in treating conditions such as depression, hypertension, or diabetes.

[. . .]

“Telemedicine was a solution to an immediate problem,” says Dr. Ateev Mahrotra, but perhaps it can become part of the long term solution too. When in-person visits return, telehealth can be used to augment the care that free medical programs provide and get more patients access to the care that they need. To do so requires defining a comprehensive telehealth policy that addresses the needs of both patients and providers with the explicit goal of increasing access to healthcare. Patients who still require in-person care or do not have access to telehealth services can still come in. Others, particularly for follow ups where it can be challenging to get patients to come back, may instead opt for a virtual visit. Setting up the facilities to provide this level of effective telehealth services at the free clinics requires funding and up-front investment from the community, local governments, and other institutions.

Sahil Nawab

Dossier

“A Cancer Patient’s Brutal Commute,” by Ateev Mehrotra and Barak Richman, July 12, 2021. https://www.wsj.com/articles/a-cancer-patients-brutal-commute-11626129627

“Telehealth for Free Medical Programs, Now and in the Future,” by Sahil Nawab, April 26, 2021. http://www.sahilnawab.com/blog/telehealth-for-free-medical-programs-now-and-in-the-future/

“We Landed at the WRONG AIRPORT! – Flight VLOG #2 – IFR BOS to PHL,” by Matt Guthmiller, February 10, 2017. https://www.youtube.com/watch?v=lmgnqKsWXGI

“Getting there is HALF THE CURE – Angel Flight – Cessna TR182,” by Aviation101, November 17, 2020. https://www.youtube.com/watch?v=bEErswxxGSg