Do you remember handling business filings or personal matters by US Mail? Me neither.
The Pandemic demonstrated the unreliability and inefficiency of doing anything of importance through US Mail.
But I, for one, don’t miss the green cards, or waiting for return receipts. Even “priority” delivery doesn’t always seem like it is at US Mail sometimes.
Electronic communication has certainly eliminated a lot of friction in our lives - especially when it comes to health care. What could be more important than staying well?
Today, online access to health records and communication with providers is easier than ever.
Frequently, I have seen test results online, even before my doctor calls to discuss them.
Yet for some, particularly older adults, that reality doesn’t exist – because they don’t have online access.
To paraphrase The Thompson Twins, a doctor can’t see a patient is “burning, burning” if the patient is not online.
Getting medical care without online access is not as easy or quick as most of us have become accustomed to over our lifetimes.
I personally encountered this challenge recently, while helping a senior citizen and former firm employee try to manage a series of challenging situations.
Her cutting-edge technology is a flip phone.
How do you send someone who has never used a website (or been online, for that matter) to go to one for information, much less to schedule an appointment or to get critical information?
I think it rivals describing a spectacular sunset or vista to a blind person.
Changing providers, or getting a second opinion, is nearly impossible without access to an online provider directory – even when her health might rapidly deteriorate without prompt treatment.
(I told her that even though such scheduling is the job of her service coordinator, she should ask her general practitioner for referrals.)
When I found opportunities for services that could help her, I had to send her information about them to her by US Mail. (But see my comment about mail service above.)
Anything available through a link was, practically, invisible to her.
Moreover, today’s busy schedules and tech driven practice management have made phone communication challenging, if not impossible, in many medical practices.
For her, leaving many “please call me” messages proved almost useless – her providers (and service coordinator) did not return her calls, at least not at a time when she could answer her phone.
I explained to her that today, a more reliable way to contact a provider is through a message on a portal – but that doesn’t work if all she has is a flip phone (or doesn’t understand what an online portal is).
In theory, one could use a computer at a library or senior center. But sometimes the need for advice from a health care provider cannot wait for scheduling of a non-urgent ride.
(And that assumes that staff at such locations could assist using a computer to leave a message, or have time to do so on a regular basis.)
I recommended that she tell each provider that although she has a portable phone, she does not have online access. I feared that her providers might assume otherwise because she has a phone, and be unable to contact her, or send her critical information.
Although her service coordinator is supposed to visit her in-person, they rarely speak – the number is often busy, or a message is not returned.
And her challenges aren’t limited to getting medical services.
For example, spontaneous trips are out, whether to a friend’s house, to a store, or to a doctor. Her ride benefits require several days’ advance booking.
She constantly carries large amounts of cash, for shopping trips – because she doesn’t have credit cards, or online financial accounts.
Unfortunately, an ever-changing cast of personal health aides (and perhaps their friends) knows that.
As a result, she has been repeatedly robbed. Even though she and her agency can narrow down the thief’s identity to a small list of suspects, proving theft of cash is difficult.
At one point, she was unexpectedly hospitalized – without her purse and contact information, or even cards with contact numbers for her benefit plans. She didn’t even have the number of her services coordinator.
(The moral for those of us with access to technology? Put all contact persons and numbers, including portal passwords, in your phone, including after-hours emergency numbers, so you – or those trying to help you when you are ill - can reach them in an emergency.)
She even mentioned that her parents are in a cemetery that happens to be where my grandparents are buried. Although the cemetery’s website offers views of selected gravesites, I could not point her to the website to look for them.
Sadly, she is not the only person suffering from a “digital disconnect.”
Our local papers recently reported that Philadelphia’s low-income housing office mandated online applications, rather than traditional paper ones.
Of course, many of those with sufficiently limited resources to qualify for low-income housing didn’t have online access and were quickly shut out when there were more applicants than homes.
But having the tools to go online doesn’t mean knowing how to use them, especially without technical support, or training about online safety.
Tech driven cost controls also limit her access to medical care, by mandating some e-services, rather than “face to face” appointments.
And the challenges aren’t limited to a disabled senior citizen. My family and I have had our own frustrations.
Personally, I long for the days when I could just give my health insurance card to my doctor’s office to get a bill paid.
Now, I have to pay an often-steep copay and self-insured amount.
When I get the doctor’s bill, I have to download an Explanation of Benefits for the service, verify that the amounts are the same, and upload it to a different site to get the bill paid.
Since our family has several ongoing health issues, our folders of bills and EOBs quickly become quite thick.
Although virtual visits have survived the Pandemic, my medical conditions still require in-person appointments.
And don’t mention HIPAA to me. I now carry copies of medical test results and history with me to appointments.
My physicians, all from the same health system but in different practices, don’t always have access to other physicians’ reports about me.
Having to educate a doctor about my medical history from memory is not a confidence building exercise.
Outside medical records, there are many “low tech” aspects of my life that I treasure, but which force me online.
The link to my local library’s online catalog will always be in my Favorites bar, at least as long as its traditional bookmobile stops near my house with its limited collection.
A hard copy book is much easier for me to read during my commute than an e-book. (This is one area where I am a self-acknowledged curmudgeon.)
Similarly, I pay to subscribe to local and national print media, even though all are available online.
However, recent prolonged delivery snafus, due to a lack of carriers, have caused weeks of missed deliveries.
But who wants to eat meals in front of a computer, or try to read the comics on a phone?
On balance, of course, I and my family are much better off with all the resources we can obtain online.
But my personal welfare is not the correct test.
As Gandhi said, “The true measure of any society can be found in how it treats its most vulnerable members”- among whom I must include the digitally disconnected.
Although huge amounts of money and effort were invested in getting all children online during the Pandemic, I don’t expect persons like our former employee to receive the same attention today.
