The collapse in telehealth volume after 2021 was widely reported as a failure. It was closer to a market finding its level: the encounters that genuinely work remotely stayed remote, and the rest came back in person.
Where remote encounters outperform
- Behavioural health follow-up, where continuity matters more than physical examination.
- Medication titration with home monitoring data available.
- Results review and shared decision-making conversations.
- Post-operative checks that are primarily about symptom review.
Where they underperform
Any encounter where the examination changes the diagnosis, any first presentation of an undifferentiated complaint, and — less obviously — any encounter where the patient’s home environment makes a frank conversation difficult. That last category is systematically under-recognised.
Designing the hybrid schedule
Do not interleave randomly
Mixing remote and in-person slots through the day produces context switching that costs more than it saves. Blocking remote encounters together preserves both the clinician’s rhythm and the room utilisation.
Triage at booking
The decision about modality should be made with clinical input at the point of booking, not left to patient preference alone. Preference matters, but it is not sufficient information.
