test results, medication initiation for chronic conditions, and as 1 physician stated, “A lot of the mental health issues can certainly be done by telehealth” (P5). Physicians also noted that medication adjustments for chronic conditions such as hypertension and diabetes could easily be done through telemedicine visits if patients have working devices at home to monitor their conditions (ie, blood pressure cuffs, glucometers). One physician observed, “I can even do diabetes follow up [with telemedicine] if I know that the patient has a good blood glucose monitor and is good about keeping data” (P7), particularly because physicians believe it is easier for patients to schedule more frequent follow-up appointments. Another physician remarked, “chronic disease management, I think can be done much more virtually. And I think we’re headed in that direction” (P12). Physicians also commented that: “advance directive talks with the family members [in] this setting is actually really great” (P6) because they could involve family members who otherwise may not have accompanied patients to in-person office visits. Seeing Patient Homes and Families during Telemedicine Visits Enhances Patient Care Physicians noted that a big advantage of telemedicine visits was seeing patients’ home environments. As 1 physician remarked about telemedicine visits: “I get to see what the inside of their house looks like and see where they live” (P7), assess potential safety hazards and home support systems, including pets. Physicians observed that they were able to interact with family members who they otherwise may have never met and, if appropriate, to involve doi: 10.3122/jabfm.2021.S1.200517 Physicians’ Experiences With Telemedicine During COVID-19 S63 on 6 July 2022 by guest. Protected by copyright. http://www.jabfm.org/ J Am Board Fam Med: first published as 10.3122/jabfm.2021.S1.200517 on 23 February 2021. Downloaded from them in the patient’s care. They also commented that medication reconciliations were easier to conduct via telemedicine because “patients can show you their medications, read the labels” (P2), whereas in the office patients often are uncertain about their medication names and regimens. Lack of Physical Examination Can Be Problematic for Diagnosis and Treatment of Certain Conditions Physicians uniformly stated that their inability to perform physical examinations is one of the main disadvantages of telemedicine visits. They noted that some complaints are particularly difficult to assess without a physical examination, such as chest pain, abdominal pain, respiratory complaints, headaches, or gynecological, musculoskeletal, or neurological symptoms. Several physicians voiced that skin rashes were difficult to examine via telemedicine, generally because of physician inability to properly visualize and feel the rash. In addition, several physicians noted that a lack of physical examination could result in antibiotic overprescribing: “I have been a little bit more inclined to treat people with an antibiotic; I have had to err on the side of being more cautious and treating people for things that, otherwise in person, I would not have felt was indicated” (P13). Worth nothing, however, is that as a result of physician inability to perform physical examinations during telemedicine visits, some physicians observed that these visits may result in better history taking because they have to “become a better detective, diagnostician in terms of asking more relevant questions because you do not have a physical examination; you have more detailed questions and review of systems” (P1) than during in-person office visits. Physicians Lament the Lack of “Personal Connections” and Touch during Telemedicine Visits All physicians spoke at length about the loss of personal connections during telemedicine visits. Whereas some believed that telemedicine and inperson interactions were similar, others noted the challenge of establishing personal connections and rapport via telemedicine, particularly with new patients. Physicians also worried about losing social cues in the virtual space. As one physician noted about the loss of seeing a patient’s body language, “It is hard to replace the in-person [visit], even if you did not need to examine the patient, because you appreciate a lot of the nuances, how the patient’s acting in the office, and stuff that you cannot appreciate over telehealth” (P5). The loss of touch during telemedicine visits bothered physicians, who felt that it detracted from their ability to perform expected rituals of care that form the backbone of physician-patient relationships. Several noted that even though a physical examination is not necessarily required during all visits, both patients and physicians have come to see the examination as being central to physicianpatient interactions. As one physician stated, “I think you lose the contact [with telemedicine]. Healing and having people feel like they are being taken care of, a lot [of] that is the physical touching part of it” (P6). Similarly, another commented, “It is an expectation within an interaction with a doctor, to listen to heart, to listen to lungs, it improves patient satisfaction ... it is kind of the ritual of the patient-physician relationship” (P2). Many physicians believed that the loss of personal connection inhibited patients from sharing personal issues during