With the sweeping rise of COVID-19, telemedicine has taken healthcare by storm. During the local surges, this served as a mandated way of maintaining safe distancing. But as things come back to a new normal and as we decide where telemedicine fi ts in to a clinic structure, it might be worth asking: should patients have the option for in-person care? Is refusing telemedicine in favor of being physically seen a choice patients should be able to make? As we begin to settle in to a fixed role for telemedicine in the post-COVID world, centers are beginning to shape processes around telehealth.

Three assumptions that we make about patients and virtual encounters give shape to our policies:

ASSUMPTION OF APPROVAL
We assume that telemedicine is what patients prefer. The belief that patients prefer to be cared for in the context of their home isn’t always the case. There may be sensitive issues or a hidden agenda that doesn’t show well across a screen.

ASSUMPTION OF EQUIVALENCE
We assume that telemedicine is as good as inperson care. There is a bias to try to assess virtually some conditions that may best be assessed in real life. But, sometimes, medicine needs to be inconvenient.

ASSUMPTION OF CAPACITY
We assume the patient is able to participate in a virtual visit. Some families lack Internet access and equipment to complete a telemedicine visit. Tech insecurity is a bigger issue than thought initially when we started doing telemedicine. There are many reasons why a patient may prefer an in-person visit. Our assumptions about the magic of telemedicine are not always right. While we should work to accommodate the preferences of the patient, patients need to understand that there are conditions and circumstances where an in-person visit is not necessary. And patients should be offered the right of refusing telemedicine.

Will our telemedicine policies pull us back to an imbalanced doctor-patient relationship? After the COVID dust falls, we need to create more structure that respects the interests and will of the patient. Telemedicine is a moving target. What works or doesn’t work today may have a very different solution or experience a year from now. Flexibility and rapid reiteration of our processes will be critical to successful adjustment and growth.

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