The Rise and Fall of Surgical Telehealth—Can Lack of Patient Connection Be Blamed?

A major result of the COVID-19 pandemic was the disruption of surgical care, especially in the early months. Resource limitations in personal protective equipment and concern for patient and clinician exposures led to a rapid increase in the use of telehealth platforms.¹ Outside of pandemic concerns, benefits for patients include convenience, quicker access to health care professionals, and minimized travel time.² While surgical use of telehealth prepandemic was limited, the pandemic experience might have been expected to result in sustained increased use.

In this issue of JAMA Surgery, Chao et al³ examined claims for surgical telehealth visits for new patients from a large Michigan commercial insurance payer. While prepandemic rates of surgical telehealth use were found to be less than 1% of new patient encounters, this increased to 34% at the height of use early in the pandemic, followed by a decrease to 3% during later months as visit volumes approached prepandemic numbers. Wide variation was noted across surgical subspecialties, with urology and neurosurgery having the highest use. Telehealth use was lower by patients in rural areas and those living in zip codes with lower median incomes.

Limitations discussed by the study authors³ include the lack of clinical details from the claims data set, only including new patient visits, and lack of race/ethnicity data. We also question the generalizability of the study results to populations across the US and note the lack of data on diagnosis codes, surgeon demographics, or travel distance affecting use of telehealth. A more complete picture addressing disparities in access and use of telehealth is needed, especially in populations with Medicaid, Medicare, or no insurance.

Although the authors³ lay the groundwork for better understanding surgical telehealth use, questions remain surrounding why telehealth has not been more widely adopted by surgeons. The authors note barriers to reimbursement despite pandemic-associated changes in billing and coding⁴ and touch on the lack of infrastructure, technical support for troubleshooting, and patient resources as challenges. The limited ability to examine patients likely affects some subspecialties and patient diagnoses more than others.¹ We postulate that perhaps the most difficult aspect of telehealth to overcome is not being able to connect with patients in person.⁵ This connection forms the bedrock of the patient-surgeon relationship and lays the foundation for trust.⁶ Trust is built using effective nonverbal and verbal communication and is especially important in conveying uncertainty, navigating difficult conversations such as bad news delivery, and managing strong emotions.⁷ Ultimately, the surgical patient experience and quality of communication via telehealth remain minimally understood. While the authors³ examined telehealth use in an insured cohort seeking surgical care during the pandemic, many additional questions are raised, and further study is warranted to better use telehealth optimally in our discipline.

Corresponding Author: Muneera R. Kapadia, MD, MME, Department of Surgery, University of North Carolina at Chapel Hill, 101 Manning Dr, Burnett Womack Building, Ste 4038, Chapel Hill, NC 27599-7081 (muneera_kapadia@med.unc.edu).

Published Online: March 26, 2021. doi:10.1001/jamasurg.2021.0989

Conflict of Interest Disclosures: None reported.