An evaluation of patient-physician communication style during telemedicine consultations.
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.
Agha
Zia
Z
Veterans Affairs San Diego Health Services Research and Development, San Diego, CA 92161, USA. zia.agha@va.gov
Roter
Debra L
DL
Schapira
Ralph M
RM
D000704:Analysis of Variance; D001291:Attitude of Health Personnel; D003142:Communication; D003299:Cooperative Behavior; D006787:Hospitals, Veterans / Q000458:organization & administration; D006801:Humans; D008171:Lung Diseases / Q000517:prevention & control / Q000628:therapy*; D008505:Medical Staff, Hospital / Q000458:organization & administration; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D010817:Physician-Patient Relations; D010865:Pilot Projects; D011320:Primary Health Care / Q000458:organization & administration*; D017216:Telemedicine / Q000458:organization & administration*; D014728:Veterans / Q000706:statistics & numerical data; D014922:Wisconsin