Roles and Responsibilities in Teleconsultation and Videoconferencing

Typical process is that information is sent to the health care provider prior to the session.


Therapeutic Clinician / Patient Relationship

The development of a therapeutic clinician / patient relationship can facilitate understanding and enhance information exchange. Information in a therapeutic relationship follows a pattern of collection of information followed by the interpretation and discussion of that information in order to arrive at a medical decision. Interaction through interpersonal communication is critical for interpretation, discussion and medical decision-making. The following sections will highlight special considerations related to the creation of a therapeutic clinician / patient relationship when using new technologies for teleconsultation.

Early investigations on the use of videoconferencing focused on the use of technology as a direct substitute for face to face communication. Technical system and software issues, led to blurred images and auditory limitations. As a result of technological advances, these system issues have taken a back seat and concerns have shifted to the development of a therapeutic clinician-patient relationship when using teleconsultation as a medium for health care.

Teleconsultation and interprofessional collaboration and professional development

The introduction of telemedicine produces changes in relationships between health care professionals (Nilsen & Moen, 2008). It facilitates knowledge transfer and enhances the quality of care that can be provided in rural centres.

Videoconferencing impacts how health care providers work together to meet the needs of patients.

Remote providers are positive and enthusiastic about the ability to connect with expert consultation in situations where immediate care is required. Videoconferencing offers the potential to reduce existing discrepancies between rural and urban service provision. Through teleconsultation and videoconferencing, remote practitioners are able to gain knowledge and experience allowing them to handle more complex situations and become less reliant on expert consultation (Weiner & Biondich, 2006).

During teleconsultation, care providers are able to share knowledge in order to facilitate effective medical decision making. Teleconsultation allows clinicians and specialists to consult and collaborate on cases. The consultant brings expert knowledge while the clinician seeking consultation often holds the context and patient specific information required for effective decision making.

Traditionally, clinicians and specialists organize their work as separate activities within their own communities (Nilsen & Moen, 2008). Labour between these practitioners is divided with patients moving between providers according to the complexity and severity of their medical issues. The use of teleconsultation technology promotes collaboration resulting in a shared understanding of the medical problem and potential interventions. Teleconsultation bridges gaps between service providers resulting in a seamless chain of treatment across organizational boundaries.

Unique communication skills required when using teleconsultation technologies

In relationship centred care the physicians seek to understand the patient’s perspective, be responsive to patient’s needs and involve patients (and families) in care decisions (shared responsibility). Physicians and patients work together in pursuing shared goals in health care with attention to both illness and personal experiences. Development of a meaningful clinician / patient relationship is dependant on the flow of both subjective and objective information through verbal, visual, emotional and tactile methods.

Physician centred communication is characterized by:

Closed ended questions, hypothesis testing to make a diagnosis, giving medical directions, controlling the interaction. This form of communication is often less successful in addressing patient needs or producing desired outcomes (Agha, Schapira, Laud, McNutt, & Roter, 2009).

Patient centred communication is characterized by:

Open ended questions, partnership building, shared decision making, information sharing, counselling, using statements of concern – agreement or approval (Agha et al., 2009). This form of communication is associated with higher patient satisfaction and improved patient outcomes (Dick, Filler, & Pavan, 1999).

Communication using teleconsultation can benefit and limit relationship focused communication patterns (Agha et al., 2009).

Benefits of teleconsultation to communication pattern

1. New technologies such as videoconferencing allow the flow of both verbal and some non verbal cues between participants
2. Use of teleconsultation can lower personal barriers
3. Interactions are less threatening or judgemental than being in same room with care provider

Limitations of teleconsultation to communication patterns

1. Trust in the IT system can erode the relationship
2. Quality of interaction – time delay in sound / eye contact
3. Design of IT system not conducive to patient interaction
4. Depersonalization of care
5. Lack of physical presence
6. Decreased non verbal communication
7. Inhibition of patient participation (comfort, sensory impairment)
8. Clinician dominance during the interaction

Techniques for enhancing the quality of communication using teleconsultation

• Clinicians require training in the use of IT systems in order to enhance relationship development.
• Clinicians need more training in communication using telemedicine technologies as well as training in communication of empathy using these technologies.
• The clinician needs to be competent and comfortable using the technology so that they may concentrate on the interview versus being distracted by the technology (Tyrrell, Couturier, Montani, & Franco, 2001).
• Given that each program is unique, training must be context-specific and designed to reflect the needs of to the community incorporating videoconferencing (Tyrrell et al., 2001).
• Experience and familiarity with teleconsultation as well as the existence of a past relationship with clinician are conducive to the development of a therapeutic clinician / patient relationship using videoconferencing technologies (Dick et al., 1999).
• Evidence suggests that patients and practitioners are able to quickly adjust to barriers related to teleconsultation and become readily accustomed to the new communication tools (Jarvis-Selinger, Chan, Payne, Plohman, & Ho, 2008).