Taking Telemedicine Visits From Your Kitchen? Think Again

Patients preferred professional backgrounds over home environments for telemedicine video visits, a survey-based cross-sectional study showed.

Using a 10-point scale, a background showing a physician office with displayed diplomas was rated highest across five domains, including knowledgeable, trustworthy, caring, approachable, and professional (mean composite score 7.8), while bedroom and kitchen environments were rated the lowest (7.2 [P=0.02] and 7.0 [P=0.002], respectively), reported Nathan Houchens, MD, of the University of Michigan and Veterans Affairs Ann Arbor Healthcare System, and co-authors.

Looking at all physician types together (a respondent could pick a different preferred background for different physician types) and compared with a solid color background (14.4%), respondents significantly preferred physician office (18.4%; P=0.007) and physician office displaying diplomas (34.7%; P<0.001), while significantly fewer preferred the bedroom (3.5%; P<0.001) and kitchen (2%; P<0.001) backgrounds, they wrote in a research letter in JAMA Network Open.

“I think it’s important to recognize that patients do have specific preferences about the background environment, and that that can potentially impact the patient-physician relationship,” Houchens told MedPage Today. “Patients really tended to gravitate toward the office with visible diplomas and credentials on the wall.”

While telemedicine isn’t new, the COVID-19 pandemic prompted unprecedented use of telemedicine. Houchens said a physician’s telemedicine background is one element of “webside manner,” which he described as “the ways in which clinicians interact with and sort of put at ease patients using telemedicine.”

“Numerous studies have found nonverbal communication to be a modifiable determinant of patient trust and satisfaction,” the authors noted.

They concluded that “healthcare systems should prioritize performing telemedicine visits within a traditional office or examination room environment.”

In the future, Houchens said he hopes to explore why patients preferred certain settings.

For this study, the researchers collected survey data from February to October 2022 from a random sample of adults who had completed either an in-person or virtual visit in the past year with the University of Michigan or Veterans Affairs Ann Arbor Healthcare System. The response rate was 30% for the university paper survey, 27% for the veterans paper survey, and unknown for the university electronic survey.

Of the 1,213 respondents, 54.1% were ages 65 and older, 53.3% were women, 84.7% were white, 7.9% were Black, 4.9% were multiracial or other, and 2.4% were Asian.

Patients were surveyed on photos of model physicians with backgrounds of different environments, including a solid color (which served as the reference), home office, exam room, physician office, office displaying diplomas, bedroom, and kitchen.

Respondents ranked each photo from 1 to 10 using the five domains on how the physician appeared and how comfortable the patient felt with them in each setting. Respondents then saw all background options and chose which ones were most preferred.

The solid color background had a mean composite score of 7.7, and other professional backgrounds were given similar scores.

Houchens and colleagues noted a few limitations to their study, including the low response rate for mailed surveys, the emphasis on a singular aspect of telemedicine encounters, and the focus on two institutions in one area, which could impact generalizability.

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