New research warns telehealth’s efficiency gains may come at the expense of human connection.
Healthcare systems have become exceptionally good at measuring efficiency through appointments completed, travel avoided, reduced wait times and other markers.
But according to new Australian research, the things easiest to count in telehealth may not be the things that matter most.
A qualitative study published in BMC Health Services Research has found that while patients and clinicians overwhelmingly value the convenience of telehealth, many also believe something fundamental is lost when therapy moves online.
That includes emotional nuance, non-verbal communication, rapport and what one participant described as the “sense of aliveness” in the room.
The study, led by researchers from Monash University and the University of Sydney, interviewed 22 psychiatrists and psychologists and 20 patients who had experienced psychotherapy both face-to-face and via telehealth.
Its central conclusion was not that telehealth is ineffective. In fact, nearly all participants praised its accessibility and flexibility, particularly for rural patients, working people, carers and those with anxiety.
But researchers argued that healthcare systems may be over-valuing the “transactional” benefits of telehealth – time saved, convenience and efficiency – while underestimating the “relational” aspects of care that are harder to quantify.
“There are indications that telehealth overall limits or constrains the exchange of meanings in the clinic,” the authors wrote.
One psychiatrist interviewed for the study described telehealth interactions as having “a two-dimensional sense of each other’s space” that could feel “abstract or alienating”.
Another clinician said online sessions lacked “a sense of aliveness sometimes in the room”.
Patients described similar experiences.
“I think the body energy is not the same as if I was there in the room,” one patient said.
Another said: “Telehealth just doesn’t quite have the same feel for me as being in the same room.”
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The study explored psychotherapy specifically, where communication itself is effectively the treatment, making subtle interpersonal signals especially important.
Researchers found both clinicians and patients believed telehealth diminished:
- body language;
- eye contact;
- pauses and conversational rhythm;
- emotional attunement; and
- the ritual and psychological preparation associated with physically attending therapy.
“The relationship part is easier in the room, and I find it much harder online,” one psychiatrist said. “In the room with a patient I can have a real human being.”
Another patient described telehealth as “good but not great communication”.
The study also highlighted the role of the physical clinical setting itself, including waiting rooms, furniture, lighting and the act of entering and leaving a therapeutic space.
One psychiatrist said the waiting room was “quite an important place” psychologically because patients often reflected before appointments.
“That doesn’t exist to the same extent in telehealth,” the clinician said.
Patients similarly described the consulting room as a form of emotional container.
“Once I left the room and closed the door my thoughts were compartmentalised,” one participant said. “The room itself is a safe space.”
Researchers argued those elements formed part of the “relational” dimensions of healthcare that are difficult to measure but potentially central to therapeutic effectiveness.
Related
While governments and health services have largely framed telehealth as a major success story, particularly for improving access and productivity, the study suggested the equation may be more complicated in mental healthcare and other communication-intensive specialties.
Importantly, the researchers did not advocate abandoning telehealth. Many participants preferred it in certain circumstances, particularly where geography, work or illness made face-to-face appointments difficult.
Instead, the paper argued telehealth and in-person care may have different optimal uses, and that policymakers should be cautious about treating them as interchangeable.
“The convenience of telehealth is undoubtedly beneficial,” the authors wrote.
“However … the change of physical presence and diminishment of interpersonal communication on telehealth means that this technology modality modifies both the structure and content of the clinical interaction.”
The researchers called for further work examining whether psychotherapy outcomes differed between telehealth and face-to-face care, and whether future technologies might address some of the communication deficits identified in the study.
Read the full study here.