JMIR Publications

ABSTRACT

Background:

While studies of physically co-present, face-to-face physician-patient interaction are abundant, relatively little is known about medical encounters conducted through video-mediated technology. Previous research indicated that particularly physical examination in the video setting poses challenges for the participants. However, we know little about how specific medical activities such as wound assessment compare between the face-to-face and video-setting.

Objective:

The objective of our study was to examine and juxtapose assessments of post-surgery wounds through a video connection and in the consultation room.

Methods:

We recorded 22 post-operative video consultations and 17 post-operative face-to-face consultations. The primary purpose of the consultation was informing the patient about the final pathology results of the resected specimen and the secondary purpose was checking on the patient’s recovery, including an assessment of the closed wound. The recordings were transcribed in great detail and analyzed using methods of Conversation Analysis.

Results:

One of the particularities of the video-consultations compared to face-to-face consultations is the way in which an assessment of the wound is established. In the consultation room, wound assessments overwhelmingly involve wound showings in the context of which surgeons report their observations formatted with evidentials (“looks neat”) and subsequently assess what these observations imply or what can be concluded from them. In contrast, wound assessments in video-consultations do not tend to involve showing the wound and, given the technological restrictions, do not involve palpation. Rather, the surgeon invites the patient to assess the wound, which opens up a sequence of patient and physician assessments in which diagnostic criteria like redness or swollenness are made explicit. In contrast to observations in regular consultations, these assessments are characterized by epistemic markers of uncertainty (“I think”, “sounds… good”) and evidentials are absent. Only in case of a potential problem, the surgeon might request the patient to demonstrate part of the body on camera.

Conclusions:

Arriving at a conclusive wound assessment in a videoconsultation requires more interactional work than in face-to-face consultations and patients have a fundamentally different role, providing their own, “lay” observations. Hence, it appears that in video-consultations physicians are dealing with a disadvantage compared to physical examination in face-to-face consultations, while patient participation is increasingly important.