Specialist–Primary Care Provider–Patient Communication in Telemedical Consultations

The use of videoconferencing enables a primary care provider and patient at one location to confer with a specialist at a distant site. Although this encounter may benefit all parties, this arrangement may also pose potential communication problems. This investigation analyzed the verbal content in typical telemedical consultations in an effort to identify patterns of talk that could affect quality of care, the specialist-primary care provider relationship, and future utilization. From the video archives of the Texas Tech Telemedicine program, 26 consultations were selected for analysis. These cases met inclusion criteria (e.g., English was spoken, the consultation was at least 10 minutes long, etc.). Four types of verbal responses were studied - information-giving, questions, controlling utterances(e.g., directives, recommendations, disagreements), and partner-centered talk (e.g., showing support, asking for another's opinion). The specialist was the most dominant communicator in terms of asking questions, displaying controlling behavior, and generally talking more than the other participants. Patients were the least active participants, and they also received the least amount of information. Group discussion was limited. Each interactant tended to talk to one participant at a time with most of the conversation occurring between the specialist and primary care provider. Differences in the way these specialists, primary care providers, and patients communicated with one another may have important implications for quality of care and future utilization of telemedicine. Future research should examine the relationship between these patterns of interaction and outcomes of care.