From the Guidelines
During the telehealth consultation, no physical examination was performed because telehealth visits occur remotely, making direct physical assessment impossible. This is a normal limitation of virtual healthcare encounters. In telehealth, providers rely on visual observation, patient-reported symptoms, medical history, and sometimes patient self-examination or vital signs if the patient has home monitoring equipment. While this approach allows for convenient access to healthcare, certain conditions may still require in-person evaluation for proper diagnosis. If the provider determines that physical examination findings are essential for clinical decision-making, they may recommend an in-person follow-up visit. This limitation is an inherent characteristic of telehealth rather than an oversight in care, representing the trade-off between accessibility and the comprehensive nature of in-person medical assessment.
Key Considerations
- Telehealth visits are remote, making physical examinations impossible 1.
- Providers use alternative methods for assessment, including visual observation and patient-reported symptoms.
- Certain conditions may require in-person evaluation for accurate diagnosis.
- The lack of physical interaction can affect the type of care a patient receives and the degree to which a physician can examine the patient 1.
Implications for Care
The inability to perform a physical examination during telehealth consultations is a significant consideration in clinical decision-making. However, telehealth can still improve access to quality healthcare, especially for underserved populations 1. By understanding the limitations and potential benefits of telehealth, healthcare providers can make informed decisions about when to use telehealth services and when in-person visits are necessary. Ultimately, the goal is to provide high-quality, patient-centered care that balances accessibility with the need for comprehensive medical assessment.
From the Research
Physical Examination in Telehealth Consultations
- A study published in 2021 2 found that a physical examination can be performed during telehealth visits, with the authors providing a methodology for guiding providers and patients in efficiently performing telehealth spine examinations.
- Another study from 2021 3 noted that difficulties in diagnosing in the absence of direct physical examination was a negative implication of delivering care via telehealth.
- A 2021 study 4 reported that patients expressed concerns regarding the absence of physical examination during telehealth consultations.
- A 2018 study 5 stated that performing the equivalent of a complete clinical examination by telemedicine would be unusual, but components of a more traditional clinical examination are part of the telemedicine workup for specific conditions.
- A 2024 scoping review 6 found that virtual physical examination has provided significant information for diagnosis during teleconsultation sessions, especially during the COVID-19 pandemic, and that patients and clinicians have found it helpful in understanding and assessing patient conditions.
Types of Virtual Physical Examinations
- The 2024 scoping review 6 identified three major types of virtual physical examinations: musculoskeletal, head and neck, and chest exams.
- The review also found that patients and clinicians have used specific technological aids, such as electronic stethoscopes and video-otoscopes, to facilitate virtual physical examinations.
Barriers to Virtual Physical Examinations
- The 2024 scoping review 6 identified several barriers to conducting virtual physical examinations, including technological challenges, efficacy concerns, confidence level of assistants, patient health conditions, health literacy, safety, and privacy.
- The 2021 study 3 also noted that technological limitations and difficulties with access to and use of technologies were negative implications of delivering care via telehealth.