Telemedicine Has Changed the Patient–Doctor Relationship: It Will Never Be the Same

In February 2020, Little J’s 7-year journey with a rare cancer, which began when he was just 17 months old, sadly ended. Our medical team had seen how pensive his father became when receiving updates. We witnessed the moments when his kind, gentle mother revealed the storms within her. We watched Little J grow from a small boy who loved monster trucks into a bright child with an engineer’s mind, like his father.

Little J’s sister grew up in hospital alongside her brother and learned to use hand sanitizer at a very young age, unaware that the rest of the world would soon do the same. His family did not live in Massachusetts, where our hospital was located, but we managed his care through a mixture of face-to-face encounters and phone calls. Had J lived a little longer, the telemedicine revolution brought by Covid-19 might have improved our communication.

As J approached the end of his life, he and his family were in Boston. Our longstanding relationship allowed us to sense their feelings beyond words. We visited them in his final days, sat on his bed and discussed death and fear together. We cried with his parents as they asked the hardest questions: How will we know when he has left his body? Should we keep his favorite lion for ourselves or place it beside him?

Little J died a few days after our visit. His funeral was among the last in-person funerals of 2020. We grieved together, shoulder to shoulder. The immense grief seemed to freeze his family’s lives. By coincidence, the entire world froze after J’s farewell too.

The Whole World Froze

The Covid-19 pandemic dramatically changed interactions between healthcare professionals and patients. The bustle of hospitals gave way to silence shaped by staffing shortages, visitor restrictions and masked faces. Social distancing in waiting rooms prevented patients and relatives from talking, sharing experiences and expressing empathy. Empty pediatric playrooms no longer needed soundproof walls.

Although the world is returning to old routines, hugs and face-to-face conversations, hospitals may have said goodbye to those days forever. Efforts to control hospital infections during the pandemic were necessary and also helped control and reduce other infectious diseases, but they profoundly affected relationships between healthcare staff and patients, and continue to do so.

Comforting patients and families, holding their hands or hugging them is a human need, particularly when a longtime patient is living their final days before our eyes. Unfortunately, personal protective equipment (PPE) limits communication to eye contact.

Has Covid-19 Had Any Positive Effects?

Despite all these difficulties, can we say Covid-19 has also had some positive effects? Is telemedicine one of them?

Its widespread adoption enabled us to reach patients in their own homes, reduce the financial impact of care on both patients and hospitals, ease travel burdens during highly stressful times, and make it easier for family members to attend visits.

It also expanded geographical access to specialists and reduced care disparities. It particularly benefited patients in under-resourced areas far from high-volume centers, which are crucial for treating rare diseases such as childhood cancers.

Telemedicine for Distant Patients

During the pandemic, rules allowing healthcare professionals to reach patients outside city centers virtually enabled distant patients to access care without traveling. Families could then decide their next steps in light of their loved one’s diagnosis and circumstances. They could consider whether distant travel was appropriate or possible, transfer options and many other choices, confident that all possible options had been explored.

Through small computer cameras, telemedicine lets us fully see one another’s expressions without infection risk. We gain far more emotional information than in visits requiring PPE. We glimpse patients’ lives, pets, art and music—everything that makes them who they are beyond their illness. Besides offering the medical team additional observation, remaining at home may reassure patients and ease anxiety, improving understanding and making questions easier to ask. Young patients can play in their rooms while their families decide the right moment to bring them into the appointment conversation.

Practicing Medicine Without a License

Against this background, the more aggressive enforcement of government restrictions on telemedicine and online appointments, catching doctors and patients unprepared, seems cruel. After months of telemedicine appointments with out-of-town patients, we were told we could not return their calls to provide medical help or hold virtual visits with them. Such interactions are now considered “practicing medicine without a license” . These bans create further turmoil for people already under stress whose lives have been overturned by illness.

Telemedicine: Better Than Nothing

Clinical teams recognize that continuity across city boundaries is crucial for high-quality care. Patients too ill to travel deserve care from familiar, trusted clinicians, especially in their final days and hours. City boundaries unfortunately feel distant to families living through these sacred but painful moments.

Critics, patients and families argue that in-person medical care is better. Yet even without the barriers of masks and PPE, this misses the central point: the real question is often whether a telemedicine visit is better than no visit at all. We believe this access should be restored for specialty/palliative care .

When Little J was diagnosed with a rare disease in a city without relevant specialists, the experience was confusing for his parents and the diagnosing doctor alike. Meanwhile, ongoing efforts to reduce specialty care costs aim to reduce admissions and visits. Why not address both needs by encouraging telemedicine appointments for patients in cities with physician shortages? Recent years have shown that healthcare inequity harms everyone, not only groups without access to medical treatment. We believe policy governing specialty care across city boundaries should be guided by the shared goal of patients and doctors: high-quality, equitable medical care for all.

It would be a devastating setback if poorly informed government policy rejected the pandemic’s success in providing care across city boundaries. We were delighted to communicate with out-of-town patients through telemedicine and thought it would last forever. As hospitals warn doctors and staff through new policies, lectures and emails that our licenses are at risk, we are now more restricted in contacting these patients than before the pandemic. Removing specialists’ telemedicine privileges will increase financial burdens on families and the healthcare system. It will also threaten the lives of patients like Little J and squander a rare opportunity to accelerate access to care.

Every patient deserves care.