COLLEGE STATION - Telemedicine has enabled greater access to health services, but the potential communication problems it brings with it could interfere with the technology's potential to improve the diagnosing and treating of illness, says a health communication authority at Texas A&M University.
Telemedicine - the delivery of health related services via remote telecommunications - is valuable for delivering health- related services to remote areas, but the dynamics of the interactions associated with it can increase the likelihood of uncertainty, frustration and unmet expectations for all involved, says Richard L. Street, who has spent more than 15 years studying health communication.
Street, working with the Texas Tech University Telemedicine program, analyzed teleconsultations involving videoconferencing between a patient and primary care giver at one location and a specialist at another in order to identify patterns of talk that could affect quality of care.
While the teleconsultation may allow the specialist and primary care provider to exchange information and ideas, such a teleconsultation may restrict patient involvement in the encounter, he says.
"While patients usually account for about 40 percent of the talk occurring in traditional consultations, they account for only 23 percent in teleconsultations," he notes.
Patients rarely asked questions or asserted a perspective or an opinion - something less than ideal considering how much a patient interacts with his or her doctor can have profound effects on diagnosis, treatment and even health improvement, Street says.
Patients who actively participate in consultations with their physicians, he explains, receive a greater amount of information, understand the issues better and are more satisfied with their care - all of which make for an overall improved quality of care.
Not only can patient participation affect the quality of a visit to the doctor, but a growing body of research indicates it can contribute to improved health and healthier behavior, Street adds.
Limited patient participation may be due to several factors, he notes.
The presence of an additional medical expert may unintentionally limit patient involvement as the two physicians converse with one another about the case, he says.
Street also points to cultural and demographic variables, noting that patients who are more involved in their consultations tend have more formal education and be in the middle to upper income bracket. However, people in remote, rural areas who are likely to have telemedicine encounters tend to be poorer and have less formal education compared to their urban and suburban counterparts.
Street also notes that very little group discussion takes place in these encounters, possibly due to the actual construct of the encounter, which places the patient and primary care giver side by side, facing a monitor with the specialist as their visual focal point.
In addition, linguistic differences play a factor. Street says clinicians often share a specialized linguistic code that allows them to better communicate but comes across as difficult-to- understand medical jargon to the patient.
He recommends that the benefits of doctors being able to talk with each other can be further enhanced if they give patients more opportunities to speak by using partnership-building methods like asking for the patient's opinion and other patient-centered responses such as offering encouragement, showing concern and interest in the patient.
"These communication strategies would both legitimize and effectively increase patient participation in these encounters," he says.
Journal
Telemedicine Journal