Making sense of technology: Use and non-use of doctor-patient video consultations in Danish general practice
Problem
Video consultations were introduced in Danish general practice in 2020. Despite a strong political push towards the use of video consultations in Denmark and a great adoption rate in times of covid, video consultations now make up less than 2% of all consultations in general practice. Still, all GPs in Denmark must offer video consultations by the end of 2024. This is problematic as we lack knowledge about the reasons for the low and fragmented video consultation use. Consequently, in this study we are the first to explore how GPs interpret video consultations and how these interpretations influence their use or non-use of the technology.
Approach
This study is based on 30 qualitative interviews with 27 Danish general practitioners conducted from August 2021 to August 2022. To study interpretative processes related to video consultations in general practice the interviews were analyzed through the lense of organizational theorists Orlikowski & Gashs’ (1994) theory about “technological frames” and technologies’ “interpretative flexibility”.
Findings
Frame 1: Video consultation as compromising occupational values: For GPs who share this interpretative frame, there is a conflict between their identity and occupational values and the introduction of video consultation which leads to non-use or very limited use of the technology. These GPs place heavy emphasis on the physical, bodily aspect of their job. Frame 2: Video consultation as crisis tool: For GPs who share this frame, the video consultation is interpreted as a “crisis-tool” due to its introduction in times of covid, making it a need-to-have technology. Some GPs tied the video consultation strongly to the pandemic situation and consequently struggled to find a place for video consultation beyond the covid-crisis. Frame 3: Video consultation as the future: For GPs who share this frame, video consultation is interpreted in a flexible and optimistic way as a technology leading to more time efficiency, freedom and improved access to healthcare. Nevertheless, not all GPs have started to use the technology. Frame 4: Video consultation as tool to improve work conditions: For GPs who share this frame, using video consultations regularly aligns well with their existing ambitions towards securing good work conditions and job satisfaction. This group of GPs believes video consultations to be a given part of their job which supports high use of the technology.
Consequences
Video consultations are differently adopted across general practices due to different interpretations of the technology and its relative advantage. Despite political goals for increased video consultation use, the future of video consultations still seems unpredictable. The relationship between occupational identity, values and use of video consultations deserves more attention. This study can help align political agendas with actual conditions of video consultation use in the clinics as political decision makers continuously push for increased use of video consultations.