Telemedicine for Surgical Consultations – Pandemic Response or Here to Stay?

A Report of Public Perceptions

Meredith J. Sorensen, MD, MS; Sarah Bessen, MPH; Julia Danford, BS; Christina Fleischer, BS; Sandra L. Wong, MD, MS

Disclosures

Annals of Surgery. 2020;272(3):e174-e180. 

In This Article

Results

Two thousand forty-two people responded to this survey. Seventy-nine were excluded for missing the attention check question, and 142 were excluded for entering invalid responses on questions which would indicate a lack of attentiveness to the survey questions. We therefore included 1827 responses in our final analysis.

Demographics of the respondents are shown in Table 1. The majority of respondents (85%) were under age 50, and 58% were male. Overall, they were well-educated, with 76% reporting at least a college degree; 27% of respondents had some medical background. The survey population tended to be employed (84% working full or part-time) and insured (87% with some form of health insurance). Only 12% of respondents were from a rural area, and most reported that they lived within 30 minutes of both their doctor's office (80%) and the nearest hospital (82%). Almost all reported compliance with social distancing measures, with 94% either not leaving home at all or going out only for essential activities.

More than two-thirds had prior experience with surgery either as a patient (72% reported having prior surgery) or via experience with a loved one going through surgery (80%). Half of respondents (49%) had experience with telemedicine, and 60% of those experiences were due to the COVID-19 pandemic (Table 2). Of the respondents who had prior experience with telemedicine (n = 891, 49%), most reported being extremely satisfied (36%) or somewhat satisfied (50%) with the encounter(s). Only 12% were unwilling to consider seeing a doctor virtually again.

In general, respondents were interested in telemedicine as a means to access the health care system during social distancing related to the pandemic: 79% preferred telemedicine for visits to their primary care providers (PCPs), with only 16% desiring to see their PCP in person. A higher proportion (24%) favored an in-person consultation with a surgeon if necessary during social distancing, but 72% would choose a telemedicine visit. Of the telemedicine modalities, video visits were preferred over telephonic ones. However, without the limitations of social distancing, 62% would prefer an in-person initial consultation with a surgeon, with only 33% choosing telemedicine (Table 3). The majority of respondents (62%) believed a virtual visit should cost less than an in-person visit, whereas 22% thought the visits should be the same cost and only 15% thought that a virtual visit should cost more.

We sought to understand the perceived importance of in-person meetings between surgeons and potential patients, and the perceived effectiveness of telemedicine to achieve certain elements of an initial surgical consultation. Nearly three-quarters of survey respondents believed it was extremely or very important to meet their surgeon in person beforethe day of surgery (71%) and to be examined by the surgeon before the day of surgery (73%). Further, they did not seem to believe this was as important to the surgeon, with only 56% and 64%, respectively, reporting that they thought it would be extremely or very important to their surgeon to meet them and examine them before the day of surgery (Figure 1). When considering 8 components of an initial visit to a surgeon (review history/reason for referral; initiate/complete diagnostic work-up; perform a physical exam; discuss treatment options; offer an opinion regarding need for/benefit of surgery; explain the technical components of the surgery; establish trust/comfort; and explain post-operative monitoring), the majority of respondents thought the physical exam (72%) and establishing trust and comfort (55%) could best be done in person. Almost half (44%) reported that initiating/completing a diagnostic workup would also be better in person. For the other 5 elements of the consultation, the majority (57%–67%) thought either an in-person or telemedicine visit would suffice. There were no elements of the initial consultation that respondents thought would be more effective virtually (Figure 2).

Figure 1.

Perceived importance of in-person meetings between patients and surgeons.

Figure 2.

Effectiveness of telehealth on various elements of an initial surgical consultation.

Survey respondents were asked to consider 6 different surgical scenarios: lipoma resection; rhinoplasty; inguinal hernia repair; thyroidectomy for cancer; pancreatic resection for cancer; and total knee replacement for severe knee osteoarthritis. Under "normal circumstances," most participants would prefer an in-person consultation for all 6 diagnoses, ranging from 64% for lipoma to 79% for pancreatic cancer. During social distancing, most respondents preferred telemedicine; as the diagnoses became relatively more complicated, the preference for in-person consultation increased. For example, only 20% preferred an in-person initial consultation with a surgeon for rhinoplasty during social distancing, but 52% would prefer it for pancreatic cancer. Interestingly, a minority of participants would delay care altogether for any of the diagnoses, with 20% of respondents reporting that they would wait for social distancing to end before consulting with a surgeon regarding rhinoplasty, and only 4% would delay consultation for pancreatic cancer (Figure 3). Survey respondents were also asked to consider the same 6 scenarios for a loved one (for whom they would be the primary caregiver). There was no difference in their preferences for in person and telemedicine visits when considering their own care versus that of a loved one.

Figure 3.

Attitudes toward telehealth under "normal circumstances" versus during social distancing.

Free text comments were reviewed qualitatively. We were unable to formally analyze the content for themes, but some topics emerged, including perceptions that telemedicine visits are more appropriate for uncomplicated visits, less appropriate for surgical consultation, and viewed relatively more favorably when access is otherwise limited. Some comments reflected concerns with technical difficulties and perceptions that telemedicine visits should be lower cost (Table 4).

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