Health care for those with female reproductive organs often involves in-person visits as doctors screen for cervical cancer, test for sexually transmitted infections and monitor pregnancies.
As the spread of the coronavirus has pushed health-care providers to quickly adapt to telemedicine options, like online chat and video conferencing, some procedures or checkups, like Pap smears, are on hold.
But many types of appointments in women’s health care need to continue to be in person, and if those visits are deferred for too long due to the coronavirus, that could lead to long-term consequences, said Dr. Deborah Money, a professor of obstetrics and gynecology at the University of British Columbia and executive vice-dean of the faculty of medicine at the school.
Tests like Pap smears — which detect early signs of cervical cancer — are vital, as is pregnancy care, said Money.
“There are obviously things we have to do in person,” Money said.
“Somebody who is a post-menopausal woman who’s bleeding, who needs an assessment, an examination and a biopsy cannot be dealt with over the phone.”
There’s concern that a rapid switch to online appointments due to COVID-19 could make access to care issues worse when it comes to women’s health, she said.
“If women are struggling to access contraceptive care, or to have an IUD inserted, COVID is exacerbating that a little bit,” she said.
“We’re trying to make sure that people prioritize those kinds of visits as considered urgent and appropriate.”
Visiting the doctor to access birth control, screen for sexually transmitted infections or address issues like severe bleeding has to continue, Money emphasized. Continuing access to abortion across the country is also paramount, she said.
But there’s still room for telemedicine when it comes to women’s health care, she said, it just depends on what’s being treated. On a given day during the pandemic, Money estimates about half her appointments are virtual visits.
“We recognize with the pressure of COVID, there are certainly things we can do over the phone in terms of a followup visit,” she said.
Money said asking how a patient is doing and if a prescribed treatment is working can be handled long distance, for example.
Innovative methods to help more Canadians obtain access to health care, including telemedicine, were already in the works prior to the pandemic, said Money.
Those who live in rural or northern communities have more trouble accessing regular health care due to a lack of family physicians and specialists in those regions, studies show. Nearly 4.8 million Canadians do not have a family doctor, according to a previous Global News report.
Barriers to accessing women’s health care in particular disproportionately impact Indigenous women, new immigrants and young women due to physician bias, according to a 2015 study out of Montreal’s McGill University. Inconsistent sex education coupled with the cost of medication, like birth control, also impacts women in rural communities more, the study found.
“We were in the habit of almost always bringing someone in for everything,” said Money.
“And when you think about marginalized communities that travelled to large centres for care, we probably have now been pushed to think in a more innovative way about how we can deliver care remotely — and virtually — that’s still complete enough and safe.”
The process so far with telemedicine has been a balance, and Money is concerned doctors may not be seeing enough people in person who need face-to-face health care. Tests like Pap smears can be held off for a few months, but eventually, patients will need to come in, she said.
“That’s what we haven’t entirely worked out.”
‘Pregnancies are still happening’
For Dr. Jane Schulz, a professor in the department of obstetrics and gynecology at the University of Alberta and the divisional director of urogynecology at the Lois Hole Hospital for Women, telemedicine has been a part of her practice for 10 years.
There aren’t many women-specific health programs in Canada, she said, so Lois Hole gets referrals from across Alberta along with northern B.C., Saskatchewan and the Northwest Territories.
While Schulz is used to not seeing patients in person, COVID-19 has posed additional challenges to getting them adequate care.
For those who are pregnant, doctors can ask about symptoms virtually, but often need to do physical checks on the individual. These can’t always be done remotely, Schulz said.
One way Lois Hole Hospital supports patients is through its antenatal home program in Edmonton where doctors visit pregnant patients and assess concerns like blood pressure or the fetal heart rate.
When a patient has to come into a health-care centre, Schulz said the hospital has been spacing out visits to limit the number of people in the office. Certain procedures, including Pap smears, have been postponed for now.
“You can’t do a Pap smear over the internet,” she said.
Schulz emphasized, however, that if you need urgent care, do not hesitate to go to the hospital or emergency room.
It’s important to reassure patients that if they need help, appropriate measures will be taken in hospital to keep them safe from COVID-19, she said.
“Pregnancies are still happening… people are still having heart attacks, people are still having cancer,” she said.
“If you have a health concern, reach out to your health provider for care.”
Questions about COVID-19? Here are some things you need to know:
Health officials caution against all international travel. Returning travellers are legally obligated to self-isolate for 14 days, beginning March 26, in case they develop symptoms and to prevent spreading the virus to others. Some provinces and territories have also implemented additional recommendations or enforcement measures to ensure those returning to the area self-isolate.
Symptoms can include fever, cough and difficulty breathing — very similar to a cold or flu. Some people can develop a more severe illness. People most at risk of this include older adults and people with severe chronic medical conditions like heart, lung or kidney disease. If you develop symptoms, contact public health authorities.
To prevent the virus from spreading, experts recommend frequent handwashing and coughing into your sleeve. They also recommend minimizing contact with others, staying home as much as possible and maintaining a distance of two metres from other people if you go out.
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