Table 2 Challenges of telehealth

Loss of connection between patients and providers

[I am] definitely [concerned about] our patients who are unhoused. Before they would be patients that might be more likely to just drop into a clinic if they needed something or needed to make an appointment because they knew they could just do that.  But now our building’s closed so they can’t. [Provider]

Communication challenges during telehealth visits

I mean the downside is people sometimes – there are people who can’t communicate effectively over the phone with you or they sometimes need you to help kind of guide them back to where the story goes. And I find those people to be very difficult to do on the phone. I think sometimes it’s hard to know whether people are minimizing their symptoms and you’re not looking at them so it’s kind of hard to tell over the phone. [Provider]

Telephone format can over focus the clinical interaction

When they’re in the room and they’re sitting down and you want to go through, “let’s go through all of your problems and all your healthcare maintenance and everything.” And I find now on the phone that really we’re focusing more on the one reason they called as opposed to all of the rest of the things that probably need to get done so I feel like we may be deferring care. [Provider]

The digital divide

I think for our patients there is also a pretty big digital divide so even if things that could be done maybe like video and show people how to do like their own things [e.g., blood pressure monitoring, etc.] […] I think that would be very hard to do just over the phone. [One of our clinic providers] tried…to pilot a Zoom™ call with one of his like 30-year-old, tech savvy patients. And [the patient] couldn’t do it. [Provider]

Difficulty with diagnoses and decision-making about triage to in-person visit

I had a 28-year-old young man with abdominal pain…And he was lower abdominal pain. But when you talked to them right on the phone I have a really hard time in sort of my training and my mindset is that the whole pain is really, really difficult to diagnose over the phone without actually touching somebody…And I don’t feel comfortable without like touching them. [Provider]