Telemedicine isn’t there yet. I’ve been treating patients for nearly a year by remote care, and I’m underwhelmed. And my patients have voted with their feet—most still want to see me in person. I suspect they’re not happy with the compromised connection that telemedicine delivers. How can marginal early experiences give way to something better?

I really believe human connection is person-toperson. From the subtleties of body language to the way a mother and baby interact, so much gets lost through the fuzzy screen. But, compromised human connection doesn’t mean there aren’t major upsides to the growth of telehealth, like my ability to care for more patients. Telemedicine has the potential to offer access where it didn’t exist; this is huge.

A good example of a helpful remote transaction that lacks nuance is the request for a medication refill over a textbased application; I don’t need more than the message to take action. On the other hand, an established teenager from hours away with ulcerative colitis having a flare needs more than a text exchange with me. Video is a great solution here, since he doesn’t have to make the 7-hour trip to see me, I know him, and the acute care encounter is truly transactional; I just need the facts to get us to the next point of care. Critical conversations, like end-of-life discussions, disclosure, and planning around lifechanging diagnoses or the exploration of certain physical problems, may be better handled with a face-to-face or hand-to-belly encounter.

While remote care may compromise raw human connection, its ability to scale connection with more patients offsets the compromise. It’s a reasonable tradeoff in many cases and one that defines the disruptive nature of telemedicine in medical practice.

We have to understand that as technology evolves, it won’t always be this way. New tools will allow new kinds of connection that will shift the telemedicine experience for doctor and patient. Next gen platforms will offer a less or differently compromised connection. It still won’t be as good as being there, but it will be better.

We may be witnessing a kind of evolution in which humans may be more comfortable engaging asynchronously, or through some kind of tool; for example, my teen doesn’t want to talk but will allow an exchange by text. Or, it may still be that we’re better in person but we’ve become frightened by the intimate reality of face-to-face engagement. While we may believe that we are best off person-to-person, we may be losing our ability to have the kind of connection that inperson affords.

Blindly accepting telemedicine in its current form is one of the worst things we can do. As end-users, we have to talk about where this technology is strong and where it isn’t. This technology needs a lot of work. And understanding this is important, because it acknowledges that telemedicine has limitations. And that’s okay. It gives us all a place to start.