Going online for doctors’ appointments and to access health care services has become a hallmark of the pandemic.

When appropriate for the health issue, communicating over a computer or phone is safer and can be easier than leaving home to drive to an appointment. But only for those with reliable, high-speed internet.

Dr. Karen Saylor, president of the Maine Medical Association, is privy to the pros and cons.

The safety of being able to access medical care from home — avoiding the COVID-related risks of going to a health care facility and being around others — has driven “an explosion” in telehealth services this past year, Saylor said. Medicare now reimbursing for such services has also been a prime motivator for clinicians to go online, she said.

“Having access to a clinician from the convenience of your home, if you have the ability to do so, really encourages people to access health care in a way that having to go to a doctor’s office does not,” Saylor said, adding, “A lot of what we used to handle in the office can easily be managed online.”

Saylor, a geriatrician with Falmouth-based Coastal Maine Direct Care, has a patient demographic that didn’t grow up with the internet and can find it challenging to navigate online services. With many of her patients having cognitive problems that make driving to her office difficult, she often has made house calls to them.

“Those folks really are the ones who would benefit the most” from telehealth, Saylor said. But living out in remote areas that lack adequate internet access, “they unfortunately are the ones who have the biggest challenges to accessing reliable internet services,” she explained. “(A lack of broadband access is) a huge disadvantage to the people who really could stand most to benefit from it.”

Saylor recalled a patient in Buckfield — one of the most distant areas to which she makes house calls — who has cognitive impairment and “terrible” internet access. “Even calling her cellphone is pretty sketchy,” Saylor said.

Saylor has attempted to videoconference with her patient through her health records system, but there’s “zero chance of that working,” the doctor said.

FaceTime communication efforts via her patient’s phone or a caregiver’s phone have also proven fruitless, so the patient either has to travel an hour to Saylor’s office or the doctor must trek out there for any interaction beyond a phone conversation.

But if patients have sufficient internet access, telehealth “opens up the whole world to them,” Saylor said. They could access not just their primary care doctor, but specialists in Boston or anywhere, she noted. “It would be such a game changer.”

Telehealth is suitable for treating anxiety, depression and mood problems, Saylor said. “You can visit with the person without being all masked up, and you can really see how they’re feeling, by their emotions and their expressions,” she said.

But if someone calls with a physical concern such as being short of breath or having abdominal pain, she needs to be able to conduct an in-person physical exam.

Like Saylor, Candy Greenberg, communications specialist with the Lakes Region Recovery Center, has seen the mixed results telehealth offers. The Bridgton peer-to-peer support organization has had to switch all of its in-person addiction support meetings to daily Zoom calls, which has “been a lifeline for people in recovery,” Greenberg said.

Candy Greenberg, communications specialist with the Lakes Region Recovery Center in Bridgton, says using telehealth can be difficult when patients have slow internet speeds, but notes that when it is working, telehealth is “a fantastic tool.” Shawn Patrick Ouellette/Portland Press Herald

Roughly 50 people attend each meeting regularly at no cost, and “we have people that have never been to meetings that are going to meetings now because they feel comfortable doing that in their home on Zoom,” including people from all over the country, she noted.

But sole reliance on the internet for those services brings occasional roadblocks, particularity among rural Mainers. “We’ve had problems just recently with people who live in the Hiram area, trying to Zoom into our meetings,” Greenberg said. “And they just don’t have the capability.”

It’s common for another member’s connection to pause as their signal buffers. Greenberg sits patiently and waits it out until the person can return, but “it’s annoying,” she admits. “I’d have people trying to talk, and trying to express to me their thoughts on recovery, and we have to wait until the internet catches up. It can be very frustrating.”

But when it’s working, it’s “a fantastic tool,” she said.

“Internet accessibility, especially now, is vital to people in recovery,” Greenberg noted, adding that she would like to see more competition among internet companies in order to offer more choices.

Greenberg, who benefits from meetings as she follows her own journey with recovery, acknowledged that a Zoom gathering can’t compete with the in-person version. “You need that camaraderie,” she said, noting that for people who rely on peer support to stay the course, “it’s been extremely difficult.”

She lamented the recent news that 58 confirmed or suspected drug overdose deaths had been reported in Maine last month — the highest figure in one month for at least the past year.

“It is staggering,” she said. “We’ve got a lot of work to do.”

Despite telehealth’s drawbacks, however, “it’s our best possible substitute,” Greenberg said. Even when the pandemic has passed and in-person meetings resume, the center plans to continue making good use of Zoom, which means broader access to reliable service will be all the more vital.

“It’s become such a tool,” Greenberg said. “And that’s what it’s all about in recovery. …You get those tools in your toolbox, and you use what works for you.”

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