How Patients Feel About Telemedicine

A couple of weeks ago, I wrote about an article that described a survey of oncologists and how they feel about telemedicine -- appointments with patients by phone or video. They mostly like it.

And I wondered then how patients felt about it (and gt a little bit of feedback from some of you). My biggest concern, as I said then, was the lack of connection that telemedicine brings. And, as I've said for a long time, Follicular Lymphoma is as much an emotional disease as a physical disease, since many of us do not have physical symptoms, while we deal with the emotional burden of having cancer. Telemedicine seems perfect for that kind of patient -- one who is maybe watching and waiting, and not dealing with actively growing cancer. But at the same time, it could be exactly the wrong kind of approach for an FL patient, who needs to kind of personal touch that telemedicine can lack. 

This week, the same journal published a separate study that looks at how patients feel about telemedicine called "Medical Oncology Patient Perceptions of Telehealth Video Visits." It's a different study -- different researchers and different methods. The study of oncologists used a large survey, while this study looks at a very small number of patients -- just 20 of them -- and instead of survey, used interviews. Interviews are nice because they usually mean more detailed answers, but they also take more time and effort, so you end up with fewer people in the study (20 patients vs almost 800 oncologists). That can throw things off a little, especially since, in this study, they are all patients at the same hospital (which might be doing a great job with telemedicine, or a really bad job).  This study only discusses video visits, not phone visits. The average age of the participants was 60.5, so many might have had problems with the technology. The point is, treat this like a phase 1 clinical trial -- not many participants, so limited in what it can tell us.

That said, the answers do make a lot of sense. (I don't have access to the full study, so I'm only going by what's in the abstract.)

The positives of video visits with the oncologist? Patients had a few responses. Convenience was one (it's certainly easier to do this by phone rather than drive to the doctor's office or hospital, especially if the patient has trouble getting around). Anxiety was another -- sometimes just driving to the office can trigger some anxiety, and being at home might be more comfortable. COVID-19 was another positive for video visits -- no danger of catching it when you're in your home. And "provider preference" was another positive (I'd love to hear more about this, because I can see that as a negative, too, if "patient preference" is to go to see the doctor in person.)

So lots of positives.

Of course, there were some negatives as well.

These include "limitations in provider connection, physical examinations, and visit length." I assume "provider connection" means the kind of emotional connection that I talk about above, though it might also mean connecting to the technology, which could be an issue for many patients. The lack of a physical exam, it seems to me, is an emotional issue as much as a physical one. There is comfort in having a doctor feel my nodes and say "That thing you feel is nothing to worry about." And visit length is kind of a surprise for me, but maybe it shouldn't be. Many of us have had to spend time on zoom or other video platforms for work, and we're tired of it. Getting out of a meeting as soon as possible is always a goal for me. Maybe it is for some doctors as well?

An interesting note in the article abstract -- when it comes to getting bad news, the patients' opinions were mixed. Some preferred a video visit because it was private, immediate, gave time to process the news, and allowed family members to be nearby for comfort. But other patients wanted to be in-person with the doctor, to get face-to-face support, written instructions, and referrals. (Personally, I wanted the news about my diagnosis right away, and it was frustrating when I had to get a phone call telling me to come in to the office a few hours later. I think I'd be OK with getting the news by telemedicine.)

The conclusion from the researchers? Doctors need to understand each individual patient's needs and desires when it comes to telemedicine. That sounds right -- we all have different needs, and sometimes our needs change. 

My fear is that, in trying to understand patients' needs, doctors (or insurance providers) don't use what they learn to push people into something they don't want.

As always, it's important that patients stand up for themselves and make their needs known. "Provider preference" is important, but patient preference needs to some first.