*3.4. Negative Experiences/Challenges of Using Digital Care Visits*

Despite numerous advantages of digital care visits, multiple drawbacks and challenges are reported in the literature. Clinicians have encountered decision-making issues, workload and workflow problems, patient-professional relationship-related considerations, patient-related challenges, or low satisfaction. These negative experiences and challenges will be presented further on.

#### 3.4.1. Complicated Decision Making

Seven studies out of twenty-eight declared that clinicians experience difficulties making decisions regarding a patient's diagnosis, treatment, or referrals [13,37–39,46,50,55]. In Koch & Guhres's paper, physicians reported that "information for decision making is limited" in digital care visits [13]. The Johnsen et al. study revealed that 15% of GPs were worried that they had possibly missed signs of serious disease. In addition, more than half of the physicians considered the inability to perform a physical examination was a serious disadvantage [38]. In another publication, it was explained that physicians think digital care visits will never be able to replace hands-on examination [55]. Sugarman et al. articulated that according to therapists' experience, it was complicated to easily treat distracted patients, to visualize their psychomotor symptoms, measure vital signs, and prescribe medication based on their observations and discussions during the digital care visit [46]. Other authors got similar findings regarding these difficulties [37,39,51,52,59]. Physicians and therapists also saw disadvantages in having to rely on the patients' observations and descriptions to diagnose, assess, or prescribe proper treatment [35,39,51,52,59]. GPs were sometimes hesitant about trusting a patient's complaints without an examination when extending their sick leaves or prescribing medication [39].

Several studies revealed that healthcare professionals had difficulties guiding the right patients to digital care visits. It was complicated for physicians to sort the patients whose conditions were appropriate to be treated via digital care visits, who needed to have an in-person visit, and who could have their problems solved by other health professionals, e.g., by nurses to utilize the limited healthcare resources efficiently [13,37,39].
