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Black Patients Are Using Telehealth More—But Can It Address Medical Racism?

Photo: Stocksy/ Julia Volk
Telehealth use increased by 154 percent during the last week of March 2020, according to the Center for Disease Control (CDC). This is, in part, because the COVID-19 pandemic forced loosened HIPPA regulations—doctors were free to use a broader range of video platforms to communicate with patients during stay-at-home orders that kept many patients inside.

For Black patients, telehealth provided increased access and comfort while interfacing with an often hostile medical system. A 2021 study published in the Journal of the American Medical Informatics Association found that increased telehealth usage among Black patients likely rose due to systemic racism that created health disparities for this group during COVID-19 as well as Black individuals perceiving the pandemic as a potential health threat.

“From a patient's perspective, it is extremely convenient to connect with a doctor from the safety and comfort of one's home, especially during this pandemic,” says Nesochi Okeke-Igbokwe, MD, a provider who has been practicing for over a decade and is currently based in the New York City area. “Telehealth also enables the patient to eliminate any travel barriers in obtaining care, especially if dealing with chronic medical problems that may warrant frequent medical visits.”

“A doctor that may hold biases against certain groups can still act on that bias during a telehealth visit..."  —Nesochi Okeke-Igbokwe, MD

Yes, telehealth helps to solve disparities rooted in access, but can the use of telehealth give Black women access to better health treatment? Even before COVID-19 disrupted our lives, Black women, in particular, navigated medical racism, with maternal mortality rates three times that of white women. Additionally, racial biases extend to other areas of medicine. A 2016 study in the Proceedings of the National Academies of Science found that medical students and residents that believed Black people have a higher pain threshold than white people were less likely to adequately care for the Black patient. In short: the traditional healthcare system often harms Black patients.

Still, despite the increased accessibility, Dr. Okeke-Igbokwe doesn’t believe telehealth is a practical solution to numerous barriers Black patients face. Instead, she considers finding solutions to eliminating implicit biases, prejudices, and racism is the real priority. “A doctor that may hold biases against certain groups can still act on that bias during a telehealth visit and not offer the same level of quality care,” she says. “Telehealth doesn't suddenly protect one against certain healthcare injustices in the form of racism.”  To achieve equitable treatment for all, Dr. Okeke-Igbokwe says we must address and eliminate the implicit biases that contribute to racial disparities in health care.

For some patients, access to Black doctors like Dr. Igoboke—both virtually and IRL—does help mitigate traumatic medical experiences. Patients can find solace (and quality care) in providers that, not only look like them but may have shared experiences. Survey results published in the Journal of the American Medical Association found that patient satisfaction was often higher when patients and physicians shared the same racial or ethnic background.

“It was important for me to go into this space to be the provider that I needed when I was younger,” says Havian Sterile, NP, is a Philadelphia-based nurse practitioner, offers her medical expertise through Nurx, an online telemedicine company focused on women’s health. “I think that directs every interaction that I’ve had.”

Sterile, who has worked both in-person and via telehealth platforms, says that virtual visits aren’t the solution to eliminating medical racism, but they can help. “It can allow the patient to feel more comfortable in asking those sensitive questions and also giving them time,” she says. “Sometimes, in brick and mortar [settings], unfortunately, there are constraints of having to tackle really complex medical issues in 15 minutes. I think telehealth gives us more time to truly spend time with the patient.”

However, Sterile says that having more Black providers goes a long way toward helping Black patients thrive. When she worked in person, Sterile says patients told her they specifically chose her because they wanted a Black provider. She sees a similar trend in telehealth patients, as many seek her out in hopes of feeling comfortable and safe.

The U.S. House of Representatives Black Maternal Health Caucus recently introduced the Black Maternal Health Momnibus Act of 2021, which includes investment "in digital tools like telehealth to improve maternal health outcomes in underserved areas” by awarding grants to entities that can expand the use of technology to areas with medically underserved populations, and areas with higher rates of maternal mortality and morbidity. On Dec. 7, Vice President Harris released a call to action “to help improve health outcomes for parents and infants in the United States” to both public and private sectors.

Ultimately, telehealth services do make healthcare more accessible, it’s one component of a large and complicated puzzle. As industries increase digital practices, equal access in those spaces must also increase—and we must all work to make healthcare more accessible overall. For each patient and healthcare provider comes different perspectives of telehealth. While it may not absolve medical racism completely for Black women, it does present more options for patients to find what works best for them.

 

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