The Typology of Physicians According to Perspectives on Telemedicine During and Beyond the Covid-19 Pandemic


Introduction: The coronavirus (CoVid-19) pandemic brought about a massive impact to the healthcare system, including disruption of patient follow-ups and consultations. Subsequently, an increase in physicians’ use of telemedicine was seen. While this technology has been documented to improve delivery of care, it has encountered varied acceptance among physicians. Gaps in specific national legislation, lack of established rules and accreditation standards, and ethical/legal implications add to the concerns. Anchored on the Unified Theory of Acceptance and Use of Technology model, this study aimed to segment physicians according to their perspectives regarding telemedicine during the pandemic.


Methods: A mixed methods sequential explanatory design using Q-methodology was applied to identify distinct patterns and perceptions of physicians on the use of telemedicine during the pandemic. A Q-sample of 25 statements on perceptions of telemedicine was developed through literature review, and 24 physicians were purposively selected. Participants were instructed to sort statements into a distribution grid according to their degree of agreement/disagreement. Post-sorting interview was conducted to expound on their response. Data were analyzed using by-person factor analysis through the PQMethod software version 2.35.


Result and Conclusion: The analysis identified four profiles which were classified under the following perspective typologies: the “Outcomes-focused Physician” focused on the importance of arriving at a correct diagnosis and lack of physical examination; the “Patient-focused Physician” considered patients’ convenience and safety during the pandemic; the “Empathy-focused Physician” gave importance to the emotional aspect of a consultation; and the “Technology-focused Physician” was concerned about the patient’s technology literacy. The results can generate insights into professional, ethical and legal implications of telemedicine in medical practice, and provide healthcare organizations, academic institutions, and policy makers information and guidance in the modification and improvement of telemedicine services in the 'new normal'.

Key words: telemedicine, perceptions, physicians, pandemic, CoVid-19

  1. World Health Organization. 90% of countries report disruptions to essential health services since COVID-19 pandemic. In: WHO global pulse survey 2020. Available from:
  2. World Health Organization. Pulse survey on continuity of essential health services during the COVID-19 pandemic, interim report 27 August 2020. Available from:
  3. World Health Organization. Rapid assessment of service delivery for noncommunicable diseases during the COVID-19 pandemic. Available from:
  4. World Health Organization. Telemedicine: Opportunities and developments in member states: report on the second global survey on eHealth 2009. Switzerland: WHO Press 2010. Available from: goe_telemedicine_2010.pdf.
  5. Betancourt JA, Rosenberg MA, Zevallos A, Brown JR, Mileski M. The impact of COVID-19 on telemedicine utilization across multiple service lines in the United States. Healthcare (Basel) [Internet]. 2020;8(4):380. Available from:
  6. Shah S, Diwan S, Kohan L, Rosenblum D, Gharibo C, Soin A, et al. The technological impact of COVID-19 on the future of education and health care delivery. Pain Physician. 2020;23(4S):S367–80.
  7. Centers for Disease Control. What is telemedicine in a non-US setting? 2020. Available from:
  8. US Department of Health and Human Sciences. Notification of enforcement discretion for telehealth remote communications during the COVID-19 nationwide public health emergency. 2020. Available from:
  9. Rockwell KL, Gilroy AS. Incorporating telemedicine as part of COVID-19 outbreak response systems. Am J Manag Care [Internet]. 2020;26(4):147–8. Available from:
  10. Department of Health. Department of Health Memorandum Circular No. 2020-0016: Guidelines for the use of telemedicine in CoViD19 response, 2020. Available from:
  11. UP medical informatics unit: Telemedicine guidance for Filipino physicians and patients [Internet]. The Endocrine Witch. 2020 [cited 2023 Apr 11]. Available from: 
  12. Salud G. Get a checkup from home: Metro manila hospitals & clinics offering telemedicine [Internet]. Tripzilla Philippines. 2020 [cited 2023 Apr 11]. Available from:
  13. Acharya RV, Rai JJ. Evaluation of patient and doctor perception toward the use of telemedicine in Apollo Tele Health Services, India. J Family Med Prim Care [Internet]. 2016;5(4):798–803. Available from:
  14. Albarrak AI, Mohammed R, Almarshoud N, Almujalli L, Aljaeed R, Altuwaijiri S, et al. Assessment of physician’s knowledge, perception and willingness of telemedicine in Riyadh region, Saudi Arabia. J Infect Public Health [Internet]. 2021;14(1):97–102. Available from:
  15. Donelan K, Barreto EA, Sossong S, Michael C, Estrada JJ, Cohen AB, et al. Patient and clinician experiences with telehealth for patient follow-up care. Am J Manag Care. 2019;25(1):40–4.
  16. El - Mahalli A, El - Khafif S. Successes and challenges in the implementation and application of telemedicine in the eastern province of Saudi Arabia. Perspect Health Inf Manag. 2012;9:1–27.
  17. Rosen D, McCall JD, Primack BA. Telehealth protocol to prevent readmission among high-risk patients with congestive heart failure. Am J Med [Internet]. 2017;130(11):1326–30. Available from:
  18. Schreiber SS. Teleneurology for veterans in a major metropolitan area. Telemed J E Health [Internet]. 2018;(tmj.2017.0202);24(9):698-701. Available from:
  19. Sood A, Watts SA, Johnson JK, Hirth S, Aron DC. Telemedicine consultation for patients with diabetes mellitus: a cluster randomised controlled trial. J Telemed Telecare [Internet]. 2017;24(6):1357633X17704346. Available from:
  20. Taylor A, Morris G, Pech J, Rechter S, Carati C, Kidd MR. Home telehealth video conferencing: Perceptions and performance. JMIR MHealth UHealth [Internet]. 2015;3(3):e90. Available from:
  21. Alami H, Fortin J-P, Gagnon M-P, Pollender H, Têtu B, Tanguay F. The challenges of a complex and innovative telehealth project: A qualitative evaluation of the Eastern Quebec telepathology network. Int J Health Policy Manag [Internet]. 2017;7(5):421–32. Available from:
  22. Martínez Álvarez M, Chanda R, Smith RD. How is telemedicine perceived? A qualitative study of perspectives from the UK and India. Global Health [Internet]. 2011;7(1):17. Available from:
  23. Greenhalgh T, Koh GCH, Car J. Covid-19: a remote assessment in primary care. BMJ [Internet]. 2020;368:m1182. Available from:
  24. Kruse CS, Karem P, Shifflett K. Evaluating barriers to adopting telemedicine worldwide: A systematic review. Journal of Telemedicine and Telecare. 2018;24(1):4–12.
  25. Helou S, El Helou E, Abou-Khalil V, Wakim J, El Helou J, Daher A, et al. The effect of the COVID-19 pandemic on physicians’ use and perception of telehealth: The case of Lebanon. Int J Environ Res Public Health [Internet]. 2020;17(13):4866. Available from:
  26. Hollander JE, Carr BG. Virtually perfect? Telemedicine for Covid-19. N Engl J Med [Internet]. 2020;382(18):1679–81. Available from:
  27. Timpel P, Harst L. Research implications for future telemedicine studies and innovations in diabetes and hypertension-A mixed methods study. Nutrients [Internet]. 2020;12(5):1340. Available from:
  28. Hanlon P, Daines L, Campbell C, McKinstry B, Weller D, Pinnock H. Telehealth interventions to support self-management of long-term conditions: A systematic metareview of diabetes, heart failure, asthma, chronic obstructive pulmonary disease, and cancer. J Med Internet Res [Internet]. 2017;19(5):e172. Available from:
  29. Knudsen LR, de Thurah A, Lomborg K. Experiences with telehealth followup in patients with rheumatoid arthritis: A qualitative interview study. Arthritis Care Res (Hoboken) [Internet]. 2018;70(9):1366–72. Available from:
  30. Warner MM, Tong A, Campbell KL, Kelly JT. Patients’ experiences and perspectives of telehealth coaching with a dietitian to improve diet quality in chronic kidney disease: A qualitative interview study. J Acad Nutr Diet [Internet]. 2019;119(8):1362–74. Available from:
  31. du Toit M, Malau-Aduli B, Vangaveti V, Sabesan S, Ray RA. Use of telehealth in the management of non-critical emergencies in rural or remote emergency departments: A systematic review. J Telemed Telecare [Internet]. 2019;25(1):3–16. Available from:
  32. Hatcher-Martin J, Factor AE. Patient acceptance and potential cost-savings of teleneurology in an academic outpatient movement disorders practice (P1.022). Neurology. 2016;86(16):P1-022.
  33. Müller KI, Alstadhaug KB, Bekkelund SI. A randomized trial of telemedicine efficacy and safety for nonacute headaches. Neurology [Internet]. 2017;89(2):153–62. Available from:
  34. Powell RE, Henstenburg JM, Cooper G, Hollander JE, Rising KL. Patient perceptions of telehealth primary care video visits. Ann Fam Med [Internet]. 2017;15(3):225–9. Available from:
  35. Provenzano D. Telemedicine healthcare for headache medicine during COVID-19 and beyond. AHM Journal [Internet]. 2020; Available from:
  36. Ballester S, Scott JM, Owei MF. Patient preference for time-saving telehealth postoperative visits after routine surgery in an urban setting. Surgery. 2018;163(4):672–9.
  37. Fryer K, Delgado A, Foti T, Reid C, Marshall J. Implementation of obstetric telehealth during COVID - 19 and beyond. Maternal and Child Health Journal. 2020;24:1104–10.
  38. Landow SM, Mateus A, Korgavkar K, Nightingale D, Weinstock MA. Teledermatology: key factors associated with reducing face-to-face dermatology visits. J Am Acad Dermatol [Internet]. 2014;71(3):570–6. Available from:
  39. Tensen E, van der Heijden JP, Jaspers MWM, Witkamp L. Two decades of teledermatology: Current status and integration in national healthcare systems. Curr Dermatol Rep [Internet]. 2016;5(2):96–104. Available from:
  40. Salongcay RP, Silva PS. The role of teleophthalmology in the management of diabetic retinopathy. Asia Pac J Ophthalmol (Phila) [Internet]. 2018;7(1):17–21. Available from:
  41. Humphreys J, Schoenherr L, Elia G, Saks NT, Brown C, Barbour S, et al. Rapid implementation of inpatient telepalliative medicine consultations during COVID-19 pandemic. J Pain Symptom Manage [Internet]. 2020;60(1):e54–9. Available from:
  42. Cota A, Tarchala M, Parent-Harvey C, Engel V, Berry G, Reindl R, et al. Review of 5.5 years’ experience using E-mail-based telemedicine to deliver orthopedic care to remote communities. Telemed J E Health [Internet]. 2017;23(1):37–40. Available from:
  43. Reider-Demer M, Raja P, Martin N, Schwinger M, Babayan D. Prospective and retrospective study of videoconference telemedicine follow-up after elective neurosurgery: results of a pilot program. Neurosurg Rev [Internet]. 2018;41(2):497–501. Available from:
  44. Indria D, Alajlani M, Fraser HSF. Clinicians perceptions of a telemedicine system: a mixed method study of Makassar City, Indonesia. BMC Med Inform Decis Mak [Internet]. 2020;20(1):233. Available from:
  45. Cantos PL, Chua NJ, Florentin MJ, Gomez TG, Hapan MF, Salmon S. Perceived level of satisfaction of Filipino patients residing in Metro Manila towards teleconsultation as new means of healthcare delivery. International Journal of Progressive Research in Science and Engineering. 2021;2(8):229–43.
  46. Peine A, Paffenholz P, Martin L, Dohmen S, Marx G, Loosen SH. Telemedicine in Germany during the COVID-19 pandemic: Multi-professional national survey. J Med Internet Res [Internet]. 2020;22(8):e19745. Available from:
  47. Cruz-Lim EM, Co HC, Mendoza MJ, Dumlao P III, Lucero JA, Yap B, et al. Physicians’ perceptions on the role of telemedicine in cancer care during and post-COVID-19 pandemic. Acta Med Philipp [Internet]. 2021;55(2). Available from:
  48. Brown SR. Q methodology and qualitative research. Qual Health Res 1996;6:561–7. Available from:
  49. Ladan MA, Wharrad H, Windle R. Towards understanding healthcare professionals’ adoption and use of technologies in clinical practice: using Q-methodology and models of technology acceptance. BMJ Health Care Inform [Internet]. 2018;25(1):27–37. Available from:
  50. Valenta AL, Wigger U. Q-methodology: definition and application in health care informatics. J Am Med Inform Assoc [Internet]. 1997;4(6):501–10. Available from:
  51. Watts S, Stenner P. Doing Q methodology: Theory, method and interpretation. Qualitative Research in Psychology. 2005;2:67–91.
  52. Barker JH. Q-methodology: An alternative approach to research in nurse education. Nurse Educ Today [Internet]. 2008;28(8):917–25. Available from:
  53. Kiwanuka A. Acceptance Process: The missing link between UTAUT and diffusion of innovation theory. American Journal of Information Systems. 2015;3(2):40–4.
  54. Venkatesh, Morris, Davis. User acceptance of information technology: Toward a unified view. MIS Q  [Internet]. 2003;27(3):425. Available from:
  55. Taiwo AA, Downe AG. The theory of user acceptance and use of technology (UTAUT): a meta-analytic review of empirical findings. Journal of Theoretical and Applied Information Technology. 2013;49(1):48–58.
  56. Tsai J-M, Cheng M-J, Tsai H-H, Hung S-W, Chen Y-L. Acceptance and resistance of telehealth: The perspective of dual-factor concepts in technology adoption. Int J Inf Manage [Internet]. 2019;49:34–44. Available from:
  57. Kamal SA, Hussain S, Shafiq M, Jahanzaib M. Investigating the adoption of telemedicine services: an empirical study of factors influencing physicians’ perspective in Pakistan. Nucleus. 2018;55(3):153–63.
  58. Bartlett JE II, DeWeese B. Using the Q methodology approach in human resource development research. Adv Dev Hum Resour [Internet]. 2015;17(1):72–87. Available from:
  59. Van Exel J and de Graaf G. Q methodology: A sneak preview. 2005:pp.1–21. Available from:
  60. Rogers EM. Diffusion of Innovations5th Ed. The Free Press 2003. New York.
  61. Cheshire WP, Barrett KM, Eidelman BH, Mauricio EA, Huang JF, Freeman WD, et al. Patient perception of physician empathy in stroke telemedicine. J Telemed Telecare [Internet]. 2021;27(9):572–81. Available from:
  62. Bashshur R, Doarn CR, Frenk JM, Kvedar JC, Woolliscroft JO. Telemedicine and the COVID-19 pandemic, lessons for the future. Telemed J E Health [Internet]. 2020;26(5):571–3. Available from:
  63. Pasco PM. Physician perspectives in the practice of telemedicine in the Philippines. J Int Soc Telemed eHealth. 2016;4:e26.
  64. Kumar P, Huda F, Basu S. Telemedicine in the COVID-19 era: the new normal. Eur Surg [Internet]. 2020;52(6):300–1. Available from:
  65. Luz PL da. Telemedicine and the doctor/patient relationship. Arq Bras Cardiol [Internet]. 2019;113(1):100–2. Available from:
  66. Silverman J, Kinnersley P. Doctors’ non-verbal behaviour in consultations: look at the patient before you look at the computer. Br J Gen Pract. 2010;60(571):76–8.
  67. Messer NG. Professional-patient relationships and informed consent. Postgrad Med J [Internet]. 2004;80(943):277–83. Available from:
  68. Terry C, Cain J. The emerging issue of digital empathy. Am J Pharm Educ [Internet]. 2016;80(4):58. Available from:

Articles related to the one you are viewing

There are currently no results to show, please try again later

Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License, which permits use, share — copy and redistribute the material in any medium or format, adapt — remix, transform, and build upon the material, as long as you give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use. You may not use the material for commercial purposes. If you remix, transform, or build upon the material, you must distribute your contributions under the same license as the original. You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit