Gloria Bachmann, MD, MMS: virtual medicine and trauma-informed care for incarcerated women

Gloria A. Bachmann, MD, MMS sat down with Michael Krychman, MD, at the North American Menopause Society (NAMS) Annual Meeting to talk about telemedicine and her work providing trauma-informed care to women in prison.

Transcript

I'm here at the North American Menopause Society Annual Meeting in Washington, D.C., and I'm really excited to have Dr. Gloria Bachmann with me here today. And she just finished presenting an amazing lecture on telehealth. So tell us what the take home messages were from your great lecture.

The take home message is that medicine is not stagnant; that we have to change not only with pandemics, but with the technology that is offered to all of us, whether we're in the healthcare field, whether we're in the arts, in the sciences; that we really have to adopt what is going to make our lives and the lives of others better. And for those of us in the healthcare field, it is technology, telehealth, and telemedicine that has really brought us to a point where we can care for individuals in a very safe way, during this COVID pandemic.

And I know as a clinician, we've been practicing telemedicine. We've been doing audio phone calls forever with our patients, but we've never kind of looked at it as a formalized delivery system for healthcare. And I know it's really exciting. For me, it's kind of like a hybrid model, right? You can do some of the things in telehealth, they really need to come in and it's really changing it. I don't think we're going to ever go back. But what about a tip for Zoom fatigue? I know I have one day that I am on Zoom for at least 10 hours. And it gets tough. Any clinical pearls for the people that are embarking on telehealth?

I think the most important aspect of telehealth is that you don't think of it as just a visual, but you can still use hand motions. You can still bring some visuals onto the screen. I know that I have lots of videos, clips that I show my patients, I have still pictures, break it up a little bit other than just talk, talk, talk, talk, talk, so that it's more interactive, rather than just the verbal.

I know sometimes I always say it's okay to turn your camera off. And I know that some patients prefer to come in, in person. So I think as we move towards this new hybrid model, you know, really exciting.

It's been a while since we've gotten together as a group of health care providers and clinicians. Tell me a little bit about how you feel about this difference between a virtual conference and an in-person conference. I know for me, in-person conferences works so much better. I mean, you get so much more out of your interactions with your peers and little sidebar discussions, after lectures. Any thoughts about where we're going to go in the future with conferences for health care providers?

I think it goes back to the Zoom fatigue, or the fatigue, that one feels just looking at a computer screen and trying to absorb everything that the person is saying. But then you're saying, 'Well, should I be multitasking now,' versus when you're actually with a group of professionals, like yourself, and we're talking, that you do maintain your attention span. You are more creative in your thinking, that I've thought of so many ideas that I want to incorporate in my practice, from being here at the North American Menopause Society, meaning from these types of discussions with others that would not have occurred if this had been a virtual meeting,

I think that it's going to be a hybrid, just like medicine. We're going to have virtual conferences, and in person, and I don't think it's ever going to go away.

I wanted to switch gears a little bit. And I know we share a passion and we kind of are involved in a little bit and I know you've been involved in New Jersey with prison health care for women, and disparities amongst health care delivery, and what have you. Any highlights you want to share with people who are the viewership for contemporary ob-gyn about prison care? Where we're going, where we've been, or some of the interesting projects that you're doing right now with prison care?

There are two important pearls that I would like to share with the audience. The first is there are many, many women, many individuals who are re-entering their communities. If I had been incarcerated for five years, and someone said to me, 'Where are you?' I would be reluctant to tell them, because they immediately think negative of me. And it's the same thing in the health care environment. So what I recommend first is that you say, 'Many of my patients have been incarcerated. Many of my patients have had intimate partner violence. Is that something that you've had? Or you've experienced? And would you like to talk about it?' I think that's the first thing, is opening up the conversation in a way that's not directed at the individual, but that you, as a healthcare provider say, 'Many of my patients had this problem, and I want to be sure you don't.

Right, it's like normalizing the situation. It's very often we use the same approach when we're talking about sexual health issues. Right? And in order to better take care of you, I ask all of my patients this as well. And I worked in a female prison for several years as well, and it's very challenging. The patients that you get are very challenging, delivery of health care is sometimes very challenging with limited resources as well. Any clinical pearls besides normalizing their history, and what have you?

Using the trauma-informed care approach, I think that is truly important. I encourage every practice to have a template of how do you deliver trauma-informed care, because one really is sensitized when they've been incarcerated, or they've had intimate partner violence, or they're addicted to substances, substance abuse. When you have a clinician who is aware of how to handle that situation so that you don't retraumatize that individual, it's very important. Also having resources, because not one of us can take care of all the needs of any individual. I have found this with my substance abuse patients, with my patients who are or have been incarcerated, that you do need other resources to also assist them for the wellness that they deserve.

What are some resources that you recommend and where can people find more information?

I can certainly give them to you, because they are clearly what we want at our disposal when we are taking care of our patients and giving them the resources. The other thing I do want to emphasize is, many times it's important to have the printed version. We have launched a journal where women can actually express some of their negative feelings, as well as their positive feelings. And so many did not have a way to electronically send the information to us that we had to have a mailing address. What I found is that sometimes you have to hand something to that individual so that they can take it home with them, rather than say, 'Well, look online.'

And it's very important, even for our patients, delivery system of information, even for clinicians. People digest information differently. Some people from social media, some people from Twitter, Instagram, other people like a physical journal to read. Other people are reading and walking on their phone. So your point is very well taken that we have to address the unmet need from for our patients as well.

Gloria, I want to really thank you so much for the opportunity to speak with you. I really appreciate your insight on telehealth, and stay tuned for a future invite to talk more about prison health.