Oct 8, 2009

Communication issues with Tele-consults , new study shows

HELP Telemedicine clinic 1








With newer technologies and net-centered consultations on the rise, this study below shows us the disadvantages of Telemedicine.



Background: The quality of physician-patient communication is a critical factor influencing treatment outcomes and patient satisfaction with care. To date, there is little research to document the effect of telemedicine (TM) on physician-patient communication.

Objective: The objectives of this study are to measure and describe verbal and nonverbal communication during clinical TM consultations and to compare TM with in-person (IP) consultations in terms of the quality of physician-patient communication.

Methods: Veteran patients (n = 19) requiring pulmonary medicine consultations were enrolled into the study. The study group included 11 patients from the Iron Mountain Veterans Affairs Hospital (VAMC) remote site. Patients had individual TM consultations with a pulmonary physician at the Milwaukee VAMC hub site. A control group of 8 patients had IP consultations with a pulmonary physician at the Milwaukee VAMC. Video recordings of medical consultations were coded for patient-physician verbal and nonverbal communication patterns using the Roter Interaction Analysis System (RIAS).

Results: There were no differences in the length of TM consultations (22.2 minutes) and IP consultations (21.9 minutes). Analysis of visit dialogue indicated that the ratio of physician to patient talk was 1.45 for TM and 1.13 for IP consultations, indicating physician verbal dominance. Physicians were more likely to use orientation statements during IP consultations (P = .047). There were greater requests for repetition from patients during TM consultations (P = .034), indicating perceptual difficulties.

Conclusions: The study findings indicate differences between TM and IP consultations in terms of physician-patient communication style. Results suggest that, when comparing TM and IP consultations in terms of physician-patient communication, TM visits are more physician centered, with the physician controlling the dialogue and the patient taking a relatively passive role. Further research is needed to determine whether these differences are significant and whether they have relevance in terms of health outcomes and patient satisfaction with care.
Patients seem to be put at a certain communication disadvantage as they are immersed into a totally new environment and need the Doctor to guide them through the interview.As technology gets better, these virtual meetings might get more realistic and take away the awe associated with high technology AND Medicine working together in tandem.

Read the full article on the JMIR site. JMIR is the leading open access journal for eHealth and healthcare in the Internet age.

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