JMIR Publications

ABSTRACT

Background:

Patient consultations in general practice are undergoing a digital transformation, embracing diverse modalities such as video, text-based, and telephone consultations. The quality of communication in medical consultations is pivotal for successful outcomes, necessitating a comprehensive assessment of the impact on the doctor-patient communication and interaction following this transformation.

Objective:

To explore GPs’ perspectives on how the communication between Norwegian contract GPs and patients has been affected by the large-scale implementation of remote consultations following the Covid-19 pandemic.

Methods:

Five focus groups, comprising 18 purposefully recruited GPs from diverse settings and geographical regions in Norway, were carried out in 2022. We applied thematic analysis, guided by the framework proposed by Braun and Clarke.

Results:

Six themes resulted from the analysis. First, suitability regarding remote communication is context dependent: knowing the characteristics of the patient as a person and the clinical relationship is more important than the reason for contact or type of health problem - even more so than during ordinary physical consultations. Second, remote consultations favor a demarcated communication style, “keeping things simple - the one problem approach” that can increase work effectiveness. Third, downsides of such effective minimalism are that uncritical use of remote consultations may undermine quality of care. Communication becomes too transactional, limiting the chances of addressing more implicit and complex issues, with the risk of missing vital information. Fourth, remote modalities can help engage hesitant and vulnerable patients. Fifth, GPs make communicative trade-offs in the name of continuity, to be able to maintain relationships with patients they see as vulnerable or fugitive. Finally, advantages and dilemmas of text-based consultations: They offer benefits such as multimedia-enabled patient expression and sharing of digital information. Nevertheless, concerns include risk of information loss through triage errors, managing informal language, and ending chat-like interactions between patients and doctors.

Conclusions:

The implementation of remote consultations introduces a spectrum of effects on clinical interaction and communication. While these modalities can enhance efficiency, there is a discernible risk of compromised retrieval of essential information and unvoiced problems, potentially resulting in unintended consequences. The preservation of continuity of care emerges as a pivotal strategy to mitigate some of these challenges. Clinical Trial: All participants signed an informed consent to participate. This study was conducted among healthcare workers, involving no patients or sensitive healthcare information. According to the Norwegian Act on Medical and Health Research §2 and §4, the study did not require approval from the regional ethics committee (REK). Interview data were safely secured in accordance with national and institutional regulations. In the transcription and publication process, personal and demographic information were anonymized to prevent indirect identification of the GPs. The procedure for handling the data was approved by the Norwegian Center for Research Data NSD/SIKT (reference: 531672).