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Face-to-face rapport
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Personability |
“Just the comfort level. If we just met with somebody, it’s so much easier to explain.” [57-year-old Asian man, Midwest] “I can express myself more, maybe, with her [provider], with her [provider] questions and answers and whatever when I’m there.” [82-year-old White woman, AZ] “I think video visits are just not personal enough. They can see maybe a hundred people on video a day.” [60-year-old African American man, AZ] “You just have a little screen to look at…I’m old fashioned I suppose.” [57-year-old White man, Midwest]
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Visual emphasis |
“...I’m a visual person. I have to see for talking to—I prefer that rather than doing—I know it would have been too, but it’s just not the same as things upfront and person to me.” [70-year-old African American woman, AZ] “I just like to look in the eyes and be there when the provider’s talking to me versus doing it on the video.” [72-year-old White man, FL] “Actually, seeing the person.” [67-year-old African American man, FL]
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Auditory emphasis |
“When I want to go see the doctor, I want to speak to my doctor.” [30-year-old White man, Midwest] “When I go for a visit to my doctor, I like to speak to my doctor, I’m old. I’m not into all these texting people, phoning people. I like to talk to people. That gets the true picture of who they are when you sit and talk to them.” [60-year-old African American man, AZ]
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Therapeutic emphasis |
“I like my doctor a lot, and I just thought I’d feel better if I could be there and visit with her [provider], especially when I started getting depressed.” [82-year-old White woman, AZ] “It’s the physical medicine doctor, and we’re about seven years apart in age. I’ve known her for perhaps five years, and the two of us just click, and I talk to her [provider] on the phone sometimes, but seeing the actual person, your friend, your doctor, that tends to be a comfort to me.” [40-year-old White woman, Midwest] “I wanted to see her [provider] in person because also, then I could briefly talk to her about more personal things just for briefly, not for a mental health visit, but in a way it was a tiny mental health visit too.” [73-year-old White woman, AZ]
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| Face-to-face therapeutic advantages |
“I believe when you’re looking at somebody from a distance of feet, your understanding of basic condition is much better than across a screen. Simple things like ADHD patients, I was talking to my cousin who’s a psychiatrist, he thinks he thinks just the way the person sits, or moves, or fidgets, and the things like that you get a lot of—an experienced doctor can make out those things that are unwritten. You miss those signals when you’re across the screen.” [57-year-old Asian man, Midwest] “I’ve been to appointments with just a regular routine physical where my doctor’s seen something that I didn’t see.” [30-year-old White man, Midwest] “For some of my appointments, I think they’re okay, but when somebody needs to really check out what’s going on inside, I think a person-to-person is much better.” [61-year-old White man, FL] “The other thing is, given that this was an orthopedic complaint, I felt that there would probably be limitations to what could be observed, diagnosed, etcetera over a zoom call, and in fact, I ended up being fitted with a brace there for a few weeks during that appointment, which would have been offered if it was something.” [36-year-old White man, Midwest]
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| Habit |
“Yeah, because I was going to see a psychiatrist...I would say it was probably just out of routine.” [50-year-old African American man, Midwest] “Other than just being new to me—I’ve never done it that way, so I guess that initial change to doing it with that method. Yeah, other than just being new to me, I’d be open to it.” [48-year-old White man, Midwest]
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| Privacy and security |
“...when you’re on a computer, you have no idea who could be listening or who it could be—who could hear you or see your or whatever. There’s a security risk there too, and not on the hospital’s end, but on your personal computer’s end or phone or whatever. There’s always a slight security risk.” [30-year-old White man, Midwest] “I know that I would feel very, very private with it the other way. I’m not sure who would be listening to me otherwise.” [76-year-old White woman, FL] “I think that’s a wonderful platform for it, if we’re staying on top of the security, the information security, but there’s enough times that you just got to have that capability to be seen in-person.” [36-year-old White man, Midwest] “to do a telemedicine visit with a psychiatrist, I had absolutely no place in my home away from my husband to have a private conversation…For me, my husband was—it's hard to believe that a well-educated woman, like me, I mean, I always vowed this would never happen, but I couldn’t even have my door closed to my room while I am on the phone or doing anything.” [73-year-old White woman, AZ]
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| Digital literacy |
“First of all, I would’ve had to have my daughter come and help me if the appointment was online.” [82-year-old White woman, Arizona] “The barriers are we aren’t set up for it here at the house. I personally struggle with the technology probably more than somebody almost 73 should.” [72-year-old White man, FL] “I’m an older person, but people who are older than me have a problem using computers sometimes. It’s more a mental thing than anything. I think they don’t want to learn computers or do anything with them.” [66-year-old White woman, AZ]
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| Internet access |
“I do not have internet, and as a matter of fact, I’m standing in the one place on my property where I have service right now.” [30-year-old White man, Midwest] “Yeah, ‘cause some places it may take them a while to link up, and by the time they send it, it’s dead.” [62-year-old African American man, Midwest] “The internet connection living in a rural area is a harder thing. We use a DSL line, so it is supposedly high-speed internet over a phone line, but it’s really not high speed, and a lot of the video sorts of things, the few times I did have to do Zoom calls for work or other social clubs, etcetera, part of my unsatisfaction with it was just that it was choppy, cutting out, etcetera, a lot.” [36-year-old White man, Midwest]
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| Body intimacy |
“Well, yeah, there are a couple I would prefer face-to-face. One of them is urology…I would prefer that because I’ve had surgery in that area, and I would prefer talking face-to-face.” [84 -year-old African American man, AZ] “I really don’t want to point the camera in some places that you need to point in a doctor’s visit.” [62-year-old American Indian man, AZ]
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| Billing |
“I don’t know that I would be comfortable getting charged the same amount if it was a telehealth appointment versus face-to-face.” [55-year-old White man, Midwest] “Well, what they need to do for billing is they need to know a hundred percent whether the insurance covers it or not before do it. The thing about it, I should not pay 240$ for something and come to find out my insurance paid for it.” [60-year-old African American man, AZ]
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| Patient portal difficulties |
“Well, I guess it comes on where you have to put in your password or whatever. That’s where I’m stuck. I don’t know what I’m doing wrong. I just have trouble.” [82-year-old White woman, AZ] “If you’re depending entirely on a phone, it’s harder because it’s a little screen. Then you have to get into the app, you have to type it with two fingers. Not everybody is good with that.” [57-year-old Asian man, Midwest] “I had some confusion trying to find the link to get to Zoom.” [54-year-old White woman, Midwest] “It’s just that it’s that technology barrier, and there’s so many people on the wrong side of that barrier right now that I think the patient portal is just—it’s not—I don’t want to say useless, but it’s not the right way to handle the situation.” [30-year-old White man, Midwest] I just loathe the portal, and even if I type in emails I get back these cryptic answers from who knows who it is in the department, and I end up calling picking up the phone and waiting and waiting and waiting and discussing it…the information doesn’t make sense, and to me it’s more stressful than just waiting for my appointment...” [71-year-old White woman, FL] “I didn’t know that I needed to download Zoom, so that was a barrier before the appointment. It was not a seamless link from your portal.” [53-year-old White woman, FL]
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Recommendations for improving telehealth appointments
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Initial visits face-to-face; follow-ups on video |
“It helps if you have one physical visit. For example, if you’re seeing somebody for the very first time, and you’ve never met them before, it might help that first visit is in-person...Because that way you’ve actually met. You’ve made eye contact once. Your comfort level has gone up a little bit. Now to conduct a second, third or follow-up calls on video might be a good idea.” [57-year-old Asian man, Midwest] “Maybe have the initial visits face-to-face and then subsequent visits over video.” [54-year-old White woman, Midwest] “...If I knew the provider, if I felt confident that the provider knew about the condition we were talking about, I think it would be idea for some follow ups.” [36-year-old White man, Midwest]
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Recommendations to help those with low digital literacy or limited internet access |
“Just making sure that their systems are not bloated or bogged down to the point that if you are talking to a person that has DSL internet or even dial-up, you get out into the really rural areas where you don’t have cables for traditional high-speed internet, and that’s still a common reality in Minnesota and Wisconsin.” [36-year-old White man, Midwest] “Maybe you guys do this already but make sure that-make people aware that they can do that [receive help setting up telehealth appointments], and that people do that all the time. There’s help available to help get you set up. Once they do one and it goes well, I’m sure they would do it again.” [66-year-old White woman, Midwest]
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