Virtual Gynecology Clinics and the Need to Include Everyone

During the pandemic, everyone was affected in one or the other way. The hospitals were overwhelmed with patients with Covid 19 while doctors were utilizing their nursing staff in the intensive care unit or the administrative ward. A major concern was the health of the patients who were awaiting surgery for either benign or malignant conditions being placed on a long waiting list. Adding to that, women’s diseases such as endometriosis and fibroids got upstaged during the delay.

Hence, there was national recognition of the need to increase the number of remote consultations, reduce the risk of transmission within healthcare, and facilitate government-imposed Covid 19 restrictions. An effort was made to provide 1 stop clinic where scanning and endometrial biopsies could be obtained under the guidance of the Royal College of Obstetricians and Gynecologists. Although video appointments or teleconsultation had transformative potential, it was the only option available to service users (SU). Following the implementation, SU faced criticisms including delays in the cancellation of appointments and problems getting in touch with them. Healthcare professionals were preferred as some felt face-to-face consultation, and the presence of family was more positive and supportive.SUs realized the need for face-to-face interaction for examination and scanning and decided on virtual delivery of follow-up cases. SUs liked the flexibility of the direct access to clinical specialist nurses who escalated the cases to HCPs if required.

However, poverty and social exclusion overlap with poor overall health, even in the UK where healthcare is free at the point of access. In a survey, accessing phone, video appointments, language barriers either because English was not their first language or SUs cannot verbalize their complaints in a legible format, phone overcrowding, domestic crowding, bad connectivity, etc were found to be new problems for women from deprived areas. The Health Foundation recommended future strategies to integrate tailored approaches for meeting the needs of different groups. One of these choices may include the modality of appointment between the healthcare professional and service user based on the range of availability. Also, patients should be given the choice to select the type of attendance, and there should be clear inclusion and exclusion criteria for virtual appointments specific to different specialties, backed up at local and national levels. 

Source: Ball E et al., AJOG Glob Rep. 2022;2(1):100043. DOI: 10.1016/j.xagr.2021.100043