The Dynamics of Doctor-Patient Communication During Remote Consultations: Qualitative Study Among Norwegian Contract General Practitioners.

backgroundPatient 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 of this transformation on doctor-patient communication and interaction.

objectiveThis study aims to explore general practitioners' (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 onset of the COVID-19 pandemic.

methodsFive 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.

resultsSix 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," which can increase work effectiveness. Third, a downside of such effective minimalism is that the uncritical use of remote consultations may undermine the 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, there are advantages and dilemmas stemming from text-based consultations. Although they offer benefits such as multimedia-enabled patient expression and sharing of digital information, some concerns include the risk of information loss through triage errors, managing informal language, and ending chat-like interactions between patients and doctors.

conclusionsThe implementation of remote consultations has many effects on clinical interaction and communication. Although 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.