Most writing about remote care is selling it. This is the other list: the things it does not do, cannot do, or does badly. It is worth having, because the failure mode of remote care is almost never "the video was bad". It is somebody waiting at home with something that needed a room, a pair of hands, or an emergency department.
It cannot examine you
This is the irreducible one. A clinician cannot palpate your abdomen, check your reflexes, look in your ears, test your gait or feel your thyroid through a screen. For cognitive complaints in particular, a neurological examination is a real part of the workup, and there is no remote version of it.
What this means in practice is not "remote care is useless for this". It means a remote clinician's job is sometimes to work out, efficiently, that you need to be in a room — and a service that never concludes that is a service that has stopped being cautious.
It cannot handle an emergency
A message thread is not an emergency service, regardless of how fast it usually replies. If something is acute — chest pain, stroke symptoms, a severe reaction to a medication, thoughts of harming yourself — the answer is your local emergency number, not your care team. In the US you can also call or text 988 for a crisis line.
This is not a disclaimer to skip past. The reason it needs saying is that remote care creates a genuinely new habit: when something is wrong, you open the app. That habit is good for the ninety-nine things that belong there and dangerous for the one that does not.
A useful rule: if you are asking yourself whether this is an emergency, treat that question itself as the signal, and use the emergency route. Nobody has ever regretted the false alarm.
It cannot draw your blood, and it can only order some of it
Remote clinicians order labs routinely — the sample is collected at a lab or by a home kit. That works well. What it does not cover is everything: some tests need specific handling, some need a clinician present, and some are only available through a particular health system.
For cognitive symptoms, the things worth ruling out are often mundane and bloodwork-shaped: thyroid function, B12 and folate, iron, glucose, sometimes sleep studies. A remote service that has never suggested any of that when you present with new fog is skipping a step.
Some testing needs a room
Formal neuropsychological testing — the several-hour kind, administered by a psychologist — is not a remote product. Neither is imaging. Neither are sleep studies that require instrumentation, although home sleep testing exists for some questions.
There are screening questionnaires that work fine remotely, and they are useful. They are also not the same thing as a diagnostic assessment, and it is worth knowing which one you have had. If a service tells you that a fifteen-question form has diagnosed you with something, be sceptical: screeners are designed to decide who needs a closer look, and they are deliberately over-inclusive.
The legal boundaries move, and they are not the same everywhere
Two of these matter most:
Where you are. A clinician generally needs to be licensed in the state or country you are physically in at the time of the appointment, not where you live. This catches people out when they travel. If you are away, say so.
What can be prescribed remotely. Rules on prescribing controlled medications — which includes most stimulants used for ADHD — without an in-person visit have been changed, extended, and re-proposed repeatedly since 2020. The situation today may not be the situation next year.
The practical version: ask directly whether a service can prescribe the specific medication you need, to you, where you live, now. This is a yes-or-no question and a service that answers it with reassurance rather than an answer is one to be careful with.
It does not replace having a clinician who knows you
Some remote services are designed to be your care; others are designed to sit alongside a practice you already attend. These are different products and they fail differently.
A service that replaces your clinician has to carry everything, including the boring continuity — refills, coordination, the referral for the thing it cannot do itself. A service that sits alongside one only works if the information actually reaches the practice. "Your symptoms travel with your record" is a claim worth testing: ask whether your clinician can see what you write, and whether they do.
Where the limits are useful
Knowing all this changes what you use remote care for, and makes it better at that. It is very good at the long middle: the weeks of adjustment after a change, the watching, the small question that would otherwise wait three months, the record that makes the next appointment start from evidence instead of from memory.
It is not good at the sharp edges. The best remote arrangements know that about themselves, say so early, and tell you where the door to the room is.