How virtual care is reshaping patient relationships, access, and equity

Virtual care is no longer an experiment—it’s a permanent and rapidly evolving part of how medicine is practiced. Yet as telehealth, remote patient monitoring, and digital tools become more embedded in everyday workflows, physicians are grappling with fundamental questions: How does care change when the exam room becomes a screen? What’s gained—and what’s lost—when in-person interactions give way to virtual ones? And can technology meaningfully expand access to care without widening existing inequities?

Medical Economics spoke with Sarah Matt, MD, MBA—a practicing physician, health technology strategist, and author of The Borderless Healthcare Revolution—to better understand how virtual care affects patient relationships, communication, trust, and equity.

(Editor’s note: Transcript has been edited for brevity and clarity.)

Medical Economics: How has the rapid expansion of virtual care changed the way clinicians interact with patients compared with traditional in-person visits?

Sarah Matt: It really depends on the practice and the specialty. Since COVID, virtual care has expanded at an exponential rate, but how it’s used varies widely depending on what kinds of doctors are seeing what kinds of patients.

For some physicians, their entire practice is now telemedicine-based. We see this a lot in women’s health, primary care, and urgent care, where the experience is 100% virtual and patients may never see their provider in person. On the other hand, many providers who previously only offered in-person visits are now working in a hybrid model. They may have specific office hours for telehealth, incorporate remote patient monitoring, or use other digital tools alongside traditional visits.

In those cases, patients might see their provider virtually for some encounters and in person for others. So instead of one dominant model, what we’re really seeing is a spectrum of care delivery approaches, and that spectrum continues to evolve.

Medical Economics: Many physicians worry that something is lost when care moves to a screen. From your perspective, what aspects of the patient–physician relationship are most at risk in remote encounters?

Matt: It can be more difficult to get a full picture of a patient when you can only see part of them, often just their face. When you see a patient in person, you pick up on so many contextual cues. What did they bring with them to the appointment? Who did they bring with them? What are they wearing? How do they move when they walk into the room?

In a virtual visit, you might only see a face and a blurred background, which limits that broader context. At the same time, it’s harder for patients to get those cues about their provider. When a patient and a physician are building a relationship, they’re subconsciously trying to understand who the other person is based on those visual and environmental signals.

As a lighthearted example, I look very tall on Zoom, but I’m not nearly as tall in person. Those kinds of mismatches sound trivial, but they’re part of how people form impressions and relationships. When those cues are missing or distorted, it can make relationship-building more challenging.

Medical Economics: What specific techniques or behaviors have you seen doctors use successfully to build trust and rapport with patients during a virtual visit?

Matt: In many ways, they’re the same techniques that matter during an in-person visit. Digital empathy and in-person empathy are equally important. Just because technology sits between the provider and the patient doesn’t mean a real relationship can’t form.

As an example, Todd, we met fairly recently, but I’d feel completely comfortable calling you now. That sense of comfort comes from the rapport we established, not the medium we used. The same applies in clinical care.

Instead of just checking boxes during a visit—whether it’s in an exam room or on a screen—providers need to focus on building a relationship. Small talk matters. Showing that you’re listening matters. Demonstrating curiosity and concern matters. Those behaviors translate across formats, and they’re just as powerful in virtual care as they are in person.

Medical Economics: How important is preparation on the doctor’s side—reviewing records, setting expectations, managing the virtual environment—to making remote visits feel more personal?

Matt: Preparation is important, but it’s also important to be realistic about the environment physicians are working in. Doctors are people, too, and they’re often being pushed to see a certain number of patients each day. They don’t always have as much preparation time as they’d like, whether visits are in person or virtual.

In many traditional practice settings, physicians are reviewing the chart just before seeing the patient. Some are lucky, depending on their specialty, to review records the night before or early that morning, but that’s not universal. Control over the physical or technical environment is also limited, especially within large systems.

For the best visits, both the patient and the provider need to be prepared. And ideally, the environment—whether physical or virtual—should feel clean, welcoming, and conducive to open conversation. That helps build trust and allows for more meaningful discussions, regardless of the care setting.

Medical Economics: Are there particular patient populations or scenarios where virtual visits can actually enhance communication or engagement compared with in-office care?

Matt: Yes, absolutely. During COVID, hospitals experimented with virtual discharge nurses, even within inpatient settings. What they found was that some older adults actually preferred interacting with a clinician through an iPad. They could turn up the volume, read lips more easily, or use transcription tools when they didn’t fully understand what was being said.

There are many scenarios where those additional communication aids are genuinely helpful. Even in person, it can be hard to concentrate in a noisy or stressful environment, and it’s easy to forget important details. In a virtual visit, patients can have a list of questions right in front of them. They can mute themselves to take a deep breath. There’s no mute button in an exam room.

There’s also the convenience factor. Patients don’t have to drive to the office, arrange childcare, or deal with the stress of commuting. Those things may not seem significant moment to moment, but they matter a great deal to patients and can meaningfully affect engagement and satisfaction.

Medical Economics: Shifting to equity, what role do you see virtual care playing in addressing longstanding disparities in access to health services?

Matt: We could spend an entire day on that question, but at a high level, I’m hopeful that telemedicine, virtual visits, and digital health tools can raise the baseline of care. Ideally, more people—whether they live in urban or rural areas, and regardless of economic status—can access better care than they could before.

Whether someone lives a block away from a doctor’s office or hundreds of miles away, virtual care, remote patient monitoring, and other tools have the potential to improve access. That said, we’re also becoming increasingly aware that not everyone has access to the infrastructure required to use these tools.

Whether someone is urban poor or lives in a deeply rural environment, reliable internet access may be lacking. I would argue that strong, consistent Wi-Fi is almost a social determinant of health at this point and should be treated like a utility. People who don’t have reliable internet with sufficient data limits are at a real disadvantage when it comes to accessing high-quality care in 2026.

Medical Economics: Access to virtual care is one thing, but if someone doesn’t have the computer or the bandwidth, that’s another level of barrier entirely.

Matt: Exactly. I used an analogy recently when speaking about this. I live in upstate New York, where we get a lot of snow. Even if you have an amazing virtual platform, remote patient monitoring, AI, and telehealth tools, none of that matters if someone lives at the end of a long, steep road during a snowstorm and the road hasn’t been plowed.

If you can’t get an ambulance to someone who needs it, technology alone isn’t going to solve the problem. There are many barriers to care that exist beyond digital tools, and we have to acknowledge and address those as well.

Medical Economics: Is there anything individual doctors can do to help patients reduce these barriers and get the care they need?

Matt: It’s difficult for individual physicians to solve these problems alone. A system-level approach is really necessary. That said, anything a provider can do to remain open to communication—whether that’s by phone, messaging, telehealth, or in-person visits—can help.

At the same time, providers need to protect their own well-being. A burned-out physician isn’t able to care effectively for anyone. A provider with a strong, stable foundation is in a much better position to help move care forward in a meaningful way.

Medical Economics: How does digital literacy on both the patient and physician side factor into whether virtual care helps or harms equity?

Matt: Digital literacy can absolutely widen or narrow disparities, depending on how it’s handled. Some patients use digital tools and AI every day, and younger generations often adopt new technologies quickly. On the provider side, we’re seeing something similar.

When I went to medical school, they gave us PalmPilots, and we thought they were magical. Today, we’re in a situation where some of the most senior providers may not be best positioned to teach trainees how to use modern digital tools, because the trainees may actually be more agile with the technology.

This means we need to lean on people across generations and communities. Teaching internet skills at libraries, setting up pop-ups at grocery stores or churches, and engaging people from different backgrounds and age groups all help. Everyone brings different expertise and perspectives.

The same applies within health care organizations. Good decision-making doesn’t come only from senior leadership. It comes from doctors, nurses, medical assistants, trainees, and senior clinicians working together.

Medical Economics: What responsibilities do physicians have to adapt their communication styles or workflows to meet patients where they are, technologically or culturally?

Matt: It’s hard to put all of that responsibility on individual physicians. Most providers work within large systems that dictate the electronic medical record, the technology platforms, and the workflows they use.

Physicians are already expected to provide excellent patient experiences while staying completely up to date on medical literature and clinical guidelines. Adding more responsibility without system support isn’t sustainable.

Health care systems need to enable providers to deliver great experiences. That means choosing technologies that support care rather than complicate it, and designing workflows that allow providers to focus on patients instead of fighting the system.

Medical Economics: Looking ahead, what design choices in virtual care platforms or care models are most critical to ensuring that remote care truly supports equitable, patient-centered care?

Matt: One of the biggest mistakes is assuming you know what patients need without asking them. Whether you’re designing care for rural farmers, urban patients who rely on public transportation, refugees who don’t speak English, or any other group, you need to include members of that group in the design process.

That means having them on advisory boards and involving them early. Otherwise, you’re essentially flying blind. You can’t design effective solutions for people without listening to their lived experiences.

Medical Economics: We’ve all seen technology that clearly wasn’t tested with the people who were supposed to use it.

Matt: Exactly. And it’s not just technology. Health care policies and care delivery models are often designed to support billing codes or scheduling efficiency, but they don’t always help patients actually get the care they need. It’s the entire ecosystem, not just the tech itself.

Medical Economics: If you could give physicians one guiding principle for using virtual care to strengthen patient relationships while reducing disparities, what would it be?

Matt: Be flexible. Some patients do great with virtual care, and some don’t. It’s not one-size-fits-all, and that applies to providers as well. Some clinicians thrive in virtual environments, while others find it doesn’t work as well for them.

The key is understanding where virtual care meets the needs of patients and where it meets the needs of providers—and being willing to adapt accordingly.

Medical Economics: Is there anything else you’d like to add?

Matt: I spent much of the past year writing The Borderless Healthcare Revolution, which became a national bestseller. For me, it’s a blueprint for improving access within the American health care system.

I wrote it because everyone has a terrible access story. No matter who you are, you’ve experienced barriers to care. I’d encourage readers to think about that roadmap and ask themselves what one thing they could do today to improve access for someone else.