Complexity and Simplicity in Doctor–Patient Email Consultations

Abstract

New technologies have facilitated doctor–patient email consultations (e-consultations). Guidelines for e-consultation use in Denmark state that they should be used for simple, concrete and non-urgent queries; however, a small-scale Danish study suggested that doctors encounter e-consultations that do not match the guidelines. The purpose of this article is to explore whether e-consultations in Denmark reflect recommendations that they should be simple, short, concrete and well defined, and if not, what forms of complexity are evident. We inductively analysed 1,671 e-consultations from 38 patients aged 21–91 years communicating with 28 doctors, 6 nurses, 1 medical student and 8 secretaries. Results showed both quantitative complexity in terms of number of interaction turns, communicative participants, and questions asked, and qualitative complexity relating to patients’ psychosocial contexts and GPs’ biomedical disease perspective. Thus, despite existing guidelines and the leanness associated with the email medium, multiple forms of complexity were evident. This mismatch highlights the need for theoretical development as well as the value of re-examining existing policies and guidelines regarding expectations for e-consultation use.

“Therefore, I would like an allergy test”

“…According to the Organisation of General Practitioners in Denmark, the e-mail consultation platform is to be used for simple and concrete queries (PLO, 2018). However, as is also found in other Danish studies of e-mail consultations (Assing Hvidt et al, 2020;Møller et al, 2021), we fi nd in our material that the patients' use of the platform does not necessarily adhere to this simple use. Rather, through affi rming their own responsibility in healthcare, making suggestions to the GP, making requests of the GP, and questioning aspects of healthcare, the e-mail consultation platform can become a communicative space used for complex tasks relating to the conduct of the body.…”

“…However, research exploring e-mail consultation content is even more limited. When e-mail consultation content is made the object of study, analyses have focused on analyzing the complexity of the e-mail content (Møller et al, 2021) or on categorizing e-mail content, e.g., relating to "clinical content" and "adminstrative content" (Atherton et al, 2020), and "medical updates", "requests for action" (Mirsky et al, 2016), or "non-acute issues" (Anand et al, 2005). One exception to this strand of research focusing on categorization is Klausen and Grønning (2021), who used a socio-technological framework to explore how bodies and bodily traces present themselves in e-mail consultations.…”

Methodological challenges in researching email consultations as a form of communication in patient-provider interactions

“…A member of staff from one of the participating practices abstracted this data for all practices. Most recently, Møller et al (2021) analysed 1671 e-consultations from 38 patients in Denmark. In studying interaction turns and questions asked, the researchers found that despite existing guidelines and the anticipated norm of e-consultations as a medium suitable only for simple communication, complexity in e-consultations is still evident in many cases and takes many forms.…”

Oralizations in e-mail consultations: A study of general practitioners’ use of non-verbal cues in written doctor–patient communication

“…Banks et al 2018, Cook et al 2016, Dash et al 2016, Fage-Butler and Nisbeth Jensen 2015, Hassol et al 2004, Hsiao et al 2011. More rarely, the actual e-mail is made the object of study, and here analyses have focused on the complexity of the e-mail content (Møller et al 2021) or on grouping e-mail content into categories such as 'non-acute issues' (Anand et al 2005), 'medical updates', 'requests for action' (Mirsky et al 2016), 'clinical content' and 'adminstrative content' (Atherton et al 2020).…”