Hello all! This week I am back with my final piece in our Patient Perspectives series. Allow me to introduce you all to...Gloria! Gloria Welechuk is a resident of a seniors lodge in Hinton, Alberta. She spends her days reading, doing puzzles, and walking the halls to get her steps in! I knew that when I started this Patient Perspectives series that I would have to interview Gloria.
Gloria is exactly the type of person who our project aims to help. She has had a hip replacement and is currently in the process of consultations for a knee replacement. Her knee replacement consult was cancelled, then rescheduled to tele-health due to the pandemic. I spoke with Gloria about her experience with her hip replacement and the ongoing process of her knee replacement. We talked about the differences she has seen between the in-person appointments she attended for her hip replacement, and her recent experiences with tele-health for her knee.
Her hip replacement was back in 2014, but before the actual surgery there was a wait of approximately a year and a half, and about five trips to the city for appointments. Gloria described it as a long, drawn out process, with most of the appointments being unnecessary. After travelling an uncomfortable three hours the night before an appointment and a hotel stay, with a bagged lunch in hand, Gloria would arrive at her appointment and wait another hour or more, only to finally get in to see her doctor for a 10 minute appointment. As well, for each appointment Gloria’s daughter needed to take time off work to drive and attend with her mom.
Recalling one of her earliest appointments, Gloria said that the doctor came in and said that he had reviewed her x-rays, and that she would need a hip replacement. The doctor then gave her a book of exercises to follow and said to go home and wait for a phone call. “End of meeting,” Gloria said. This was very discouraging after making the trip to Edmonton, only to be told to wait for a phone call. The exercises in the book were not described or demonstrated for Gloria - sending the book by mail could have saved the pain and stress of travelling, not to mention the extra expenses that come with a trip to Edmonton.
These trips to Edmonton are difficult for anyone, but even more so for someone who is in pain. Gloria was in a lot of pain before her hip surgery, and spent over $100 to try and find a cushion that fit in her vehicle and was comfortable for the long trip. Once she finally got to have the surgery, she was sent home after only two days with just a bag of ice and a pain medication prescription to fill. This made for a very uncomfortable trip home, only made harder by the lack of accessible washrooms along the route home. Gloria tells me they stopped in Devon, which has the only accessible bathroom between Edmonton and Edson.
Once Gloria returned home to the lodge, her daughter stayed with her for three days and she began to do the recommended exercises. She followed the exercises carefully and healed quickly, walking without her walker just a month and a half after the surgery! Then began the follow-up appointments, eventually leading to a two year check-up, which Gloria ultimately cancelled because she was walking properly with no pain or difficulty and didn’t think it was worth the trip for them to say “yes, you’re fine, go home.”
This burden of travelling to an appointment in the city is not felt by those residing in urban centres. The barriers that rural residents face creates a disparity in healthcare. For Gloria, it made sense to her to avoid the hassle of yet another trip to Edmonton for a follow-up appointment, especially since everything was going well. However, without these follow-up appointments, complications can easily be overlooked, and we miss the chance to collect outcome data for patients. This story clearly shows that, without equitable access, our healthcare system is unable to adequately serve all Albertans.
When I asked Gloria how she initially felt about having an in-person appointment replaced with a phone call, she said she felt good, given her experience with her hip replacement appointments. She did have to purchase a new phone with speakerphone capabilities, but once she had the phone it was smooth sailing. Gloria’s daughter attended the call, and the doctors had received Gloria’s x-rays, which made her feel comfortable. The call started at the scheduled time and was quick and easy. Overall, Gloria liked having the appointment as a phone call because, for this appointment at least, there was no need for her to be physically assessed.
We can see a huge difference when we compare Gloria’s experience with her hip replacement to the start of her journey for a knee replacement. The major issues she encountered with the hip replacement have so far been negated with virtual care. Without the need to travel to Edmonton, Gloria didn’t have to sit through hours of discomfort in the car. She wasn’t frustrated by a long wait in the waiting room, didn’t have to pay for a hotel, and her daughter was able to take off only a few hours from work instead of a few days. Through her virtual appointment, Gloria was able to get a prescription for a knee brace, and the communication through the call was clear. Although she has only had one virtual appointment so far, she is optimistic that her second call, which will hopefully be in September, will be successful as well.
This is not to say that there are no challenges or concerns with virtual appointments. Gloria definitely felt less of a personal connection to her doctor over the phone because she was unable to see their face. Her daughter still had to take time off work to attend, as Gloria was concerned she may not hear all the important things her doctors had to say. Additionally, the burden of having the appropriate technology fell directly on Gloria’s shoulders. She had to venture out during the pandemic to purchase a phone that would work properly for the appointment, and going to the store in a time where seniors are especially vulnerable due to the virus was very stressful.
For her appointment in September, Gloria does have some concerns about how her doctors will assess her muscles for wasting or growth, and is especially concerned that they won’t have access to a more recent x-ray to help verify her condition. It’s clear that even though virtual care has been massively successful thus far, we still have a long way to go to build confidence in our ability to care for patients virtually.
The challenges that Gloria expressed during our talk really highlighted for me how necessary a project like Tele-Rehab 2.0 is. It seemed to me like we had perfectly designed solutions for the issues she brought up. We use video conferencing with Zoom and Double Robotics so that appointments retain that personal connection. There is a general clinician present with the patient for any hands-on pieces that are required. Our model also facilitates clinician communication in real time, instead of relying on the patient to be a go-between. Gloria’s concerns about the subjectivity of a phone call are addressed by our mobile EMG device (currently in development) which will allow clinicians to objectively measure strength and track improvements made over time. This tracking also means she can be encouraged by seeing her progress in a visual format.
Stories like Gloria’s are incredibly motivating for our team and for healthcare professionals across the province. This summer’s Patient Perspectives series has tried to highlight how virtual care, like Tele-Rehab 2.0, can make a difference in the lives of everyday Albertans. I hope that you’ve enjoyed reading these stories as much as I enjoyed connecting with these amazing individuals. This will be the last piece in the series from me, but I hope that patients continue to share their stories with our Tele-Rehab 2.0 team, so that we can keep advocating for better, more equitable care in Alberta.
Special thanks to Gloria Welechuk for speaking with me and sharing your experiences so freely. Your story is so valuable to our work and to the future of healthcare.