Abstract
BackgroundVideo-mediated clinical consultations offer potential benefits over conventional face-to-face in terms of access, convenience, and sometimes cost. The improved technical quality and dependability of video-mediated consultations has opened up the possibility for more widespread use. However, questions remain regarding clinical quality and safety. Video-mediated consultations are sometimes criticized for being not as good as face-to-face, but there has been little previous in-depth research on their interactional dynamics, and no agreement on what a good video consultation looks like.ObjectiveUsing conversation analysis, this study aimed to identify and analyze the communication strategies through which video-mediated consultations are accomplished and to produce recommendations for patients and clinicians to improve the communicative quality of such consultations.MethodsWe conducted an in-depth analysis of the clinician-patient interaction in a sample of video-mediated consultations and a comparison sample of face-to-face consultations drawn from 4 clinical settings across 2 trusts (1 community and 1 acute care) in the UK National Health Service. The video dataset consisted of 37 recordings of video-mediated consultations (with diabetes, antenatal diabetes, cancer, and heart failure patients), 28 matched audio recordings of face-to-face consultations, and fieldnotes from before and after each consultation. We also conducted 37 interviews with staff and 26 interviews with patients. Using linguistic ethnography (combining analysis of communication with an appreciation of the context in which it takes place), we examined in detail how video interaction was mediated by 2 software platforms (Skype and FaceTime).ResultsPatients had been selected by their clinician as appropriate for video-mediated consultation. Most consultations in our sample were technically and clinically unproblematic. However, we identified 3 interactional challenges: (1) opening the video consultation, (2) dealing with disruption to conversational flow (eg, technical issues with audio and/or video), and (3) conducting an examination. Operational and technological issues were the exception rather than the norm. In all but 1 case, both clinicians and patients (deliberately or intuitively) used established communication strategies to successfully negotiate these challenges. Remote physical examinations required the patient (and, in some cases, a relative) to simultaneously follow instructions and manipulate technology (eg, camera) to make it possible for the clinician to see and hear adequately.ConclusionsA remote video link alters how patients and clinicians interact and may adversely affect the flow of conversation. However, our data suggest that when such problems occur, clinicians and patients can work collaboratively to find ways to overcome them. There is potential for a limited physical examination to be undertaken remotely with some patients and in some conditions, but this appears to need complex interactional work by the patient and/or their relatives. We offer preliminary guidance for patients and clinicians on what is and is not feasible when consulting via a video link.International Registered Report Identifier (IRRID)RR2-10.2196/10913
Highlights
BackgroundThere is a significant push from decision makers across the world to make better use of digital technologies, including video consultations [1,2,3]
We conducted an in-depth analysis of the clinician-patient interaction in a sample of video-mediated consultations and a comparison sample of face-to-face consultations drawn from 4 clinical settings across 2 trusts (1 community and 1 acute care) in the UK National Health Service
There is potential for a limited physical examination to be undertaken remotely with some patients and in some http://www.jmir.org/2020/5/e18378/
Summary
There is a significant push from decision makers across the world to make better use of digital technologies, including video consultations [1,2,3]. Published research on video outpatient consultations has been summarized in several recent reviews [7,8,9,10] These show great potential for video consultations in terms of acceptability, safety, and effectiveness in patients considered clinically eligible across a range of conditions, such as diabetes [11,12,13,14,15], ophthalmology [16], cancer [17,18], chronic kidney disease [19], spinal cord injury [6,20,21], chronic obstructive pulmonary disease [22,23], mental health conditions [24,25], Down syndrome [26], cerebral palsy [27], chronic pain [18,28,29], therapies (eg, speech and language therapy [30,31,32]), support after premature birth [33], support of patients in care homes [34], and plastic surgery [35]. Video-mediated consultations are sometimes criticized for being not as good as face-to-face, but there has been little previous in-depth research on their interactional dynamics, and no agreement on what a good video consultation looks like
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