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Abstract
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Clinical activities to do with non-life-threatening disease were deemed nonessential to controlling the COVID-19 outbreak. Nursing and paramedical staff were dispatched to acute care settings, and patient visits in most of the sectors that manage chronic conditions were suspended. Despite the initial difficulties of setting up telecommunications so that I, a physician specializing in headache medicine, could provide health care services remotely, most of my patients were grateful for the option of telehealth; it became a means for them to safely maintain medical contact with me.
However, I also realized this new model of care was not in the best interests of all my patients.
There is widespread concern about the detrimental effects of confinement in vulnerable patient populations that lack social network support groups.Footnote 1 In particular, victims of domestic abuse have reported increased risk of violence.Footnote 2 Because I care for patients who are not only predominantly female but also have an innate brain hypersensitivity to aversive stimuli, I am often entrusted with sensitive information about headache triggers, such as emotional distress caused by conjugal violence.Footnote 3
The COVID-19 pandemic contingency directives did not authorize in-person medical visits for victims of intimate-partner violence (IPV). In-person medical visits have been limited to physical examinations in the case of an acutely fatal condition, such as a thunderclap headache suggestive of an intracranial bleed, or hardware malfunctions of technology-based therapeutic devices, for example, parenteral drug delivery systems and implantable nerve signalling modulators.Footnote 4Footnote 5 Fortunately for these patients, my hospital's institutional authorities were receptive to my request to maintain in-person medical visits, regardless of their headache status. Of course, these patients are screened for COVID-19 infection 24 hours or less prior to the appointment, and safety measures such as hand hygiene, mask wearing and physical distancing are mandatory.
A non-urgent or non-life-threatening service does not equate to a nonessential service. For victims of IPV, accessing health care involves challenges related to cost, fear of facing prejudice and discrimination, the controlling tactics of abusive partners and a low sense of self-efficacy.Footnote 6Footnote 7Footnote 8 Contingency regulations necessary to control the pandemic have further increased vulnerability to IPV, through the crises created by job losses and displacement as well as social isolation caused by mandatory physical distancing.
Despite a predicted rise in IPV incidents, emergency response support services have seen a decrease in the numbers of victims reaching out, likely a consequence of IPV victims' concern at potentially exposing themselves and their loved ones to infection as well as being entrapped with their abuser...
Language: fr |