The Dynamics of Doctor-Patient Communication in Remote Consultations. A qualitative Study among Norwegian Contract GPs

Problem

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 how communication between Norwegian contract GPs and patients has become affected by large-scale implementation of remote consultations, after resolution of the pandemic

Approach

Methods: In 2022, five focus groups were convened, comprising 18 GPs strategically recruited from diverse geographical regions in Norway. Thematic analysis, guided by the framework proposed by Braun and Clarke, was inductively applied to the collected data. Deductive application of the trust theory proposed by philosopher Harald Grimen were employed in theme development.

Findings

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 favour a demarcated communication style, “keeping simple things simple,” that can increase work effectiveness. Third, opposite, a downside of such effective minimalism is 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 consultations can facilitate establishment of alliances with patients who find it easier to open sensitive topics by distance than in a physical encounter. Fifth, GPs make communicative compromises to be able to maintain relationships with patients they see as vulnerable or fugitive. Finally, text consultations offer benefits such as multimedia-enabled patient expression and the 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.

Consequences

Implications: Implementation of remote consultations introduces a spectrum of effects on clinical interaction and communication. While these modalities can enhance efficiency, there exists 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.