Survey: Virtual Visits Have Their Benefits (and Distractions)

A new survey finds that both patients and providers see value in telehealth visits as a complement to in-person care but not a replacement. And they don't like distractions.

A survey of patient and provider attitudes toward telehealth find that both see the virtual visit as a complementary to the in-person visit, but not as a replacement. And they both certainly know when a virtual visit isn't working.

Compiled by the New York-based telehealth scheduling company Zocdoc, the survey, taken separately of patients and care providers between May 2020 and May 2022 and combined with an analysis of appointment bookings, charts the increase in telehealth visits during the pandemic and a decrease in recent months as the COVID-19 crisis has waned. It found that roughly one-third of all visits were virtual in 2020, as the pandemic peaked, and that number dropped to 17% as of May 2022.

The one exception is in mental health services. Some 74% of mental health appointments were for virtual services in May 2020, and that number rose to 85% in May 2021 and has increased to 87% in May 2020. The numbers show that both patients and providers are finding a comfort zone in telehealth for mental and behavioral health services.

Perhaps more intriguing are the challenges that come with a virtual visit. According to the survey, providers noted the following distractions:

• A patient plucking their eyebrows during the appointment, not realizing the video was on;
• Patients taking video calls while using the bathroom;
• A cat jumping on a client's head during hypnosis;
• A patient rollerblading on the beach during an appointment; and
• Children interacting while their parents were meeting virtually with a care provider, either with the parent (playing peek-a-boo) or talking to the provider.

And patients weren't the only transgressors. According to the survey, patients noted the following issues with their care providers:

• A provider with a frozen video screen, which the patient mistook for an "impressively focused, intense gaze;"
• An unmade bed in the background;
• A provider conducting the virtual visit from his car;
• A provider's cat grooming itself for 45 minutes in the background; and
• Meeting a provider's "really cute!" pet parrot.

Those observations point to the value of educating both patients and providers on how to conduct a virtual visit. Health systems should be training their care providers on how to present themselves during a virtual visit, and they should also be communicating to their patients how those visits should be handled on that end.

That said, telehealth can give the care provider an opportunity to see the patient's home environment and routines, which can factor into both diagnosis and treatment. According to the survey of providers, 36% reported seeing a patient's pet, 31% saw a family member or roommate, and 42% saw a patient outside of the house.

Healthcare providers have often said that a telehealth visit with the patient in his or her home can offer insights into habits and lifestyle that aren't seen or talked about in in-person visits, and which can affect healthcare delivery and outcomes. For example, a mental healthcare provider might be able to see certain stressors in the home that affect a patient's mental health, while a doctor treating a patient living with diabetes might gain better insight into how that patient eats and exercises each day.

Aside from pointing out the benefits and challenges of seeing patients and care providers via video, the Zocdoc study highlights the importance of treating telehealth as a part of the healthcare process, not as a replacement for in-person care. The platform offers certain advantages, with patients reporting that it's convenient and can eliminate the burden of taking time off from work or school, hopping in the car or taking a bus and travelling to a doctor's office.

But it's not always the right mode of care, with providers opining that it doesn't allow them to fully examine a patient. According to the survey, 58 percent of providers said it was more difficult or much more difficult to examine patients, and a quarter said it wasn't possible to provide the type of care patients expect via telehealth. Some 37% of providers said it was more difficult or much more difficult to build a relationship with patients via telehealth, and only 7% said it was easier (interestingly, 31% or patients felt it was easier to build a relationship with a provider via telehealth, saying the decreased level of formality in a virtual visit enabled them to be more comfortable).

The path for health system executives going forward is to highlight the benefits of telehealth and present that as an option to in-person care when appropriate, and to point out that telehealth can support in-person care but doesn't have to replace it.