General Practitioners’ Experiences With Potentials and Pitfalls of Video Consultations in Norway During the COVID-19 Lockdown: Qualitative Analysis of Free-Text Survey Answers

Abstract

Background The use of video consultations (VCs) in Norwegian general practice rapidly increased during the COVID-19 pandemic. During societal lockdowns, VCs were used for nearly all types of clinical problems, as in-person consultations were kept to a minimum. Objective This study aimed to explore general practitioners’ (GPs’) experiences of potentials and pitfalls associated with the use of VCs during the first pandemic lockdown. Methods Between April 14 and May 3, 2020, all regular Norwegian GPs (N=4858) were invited to answer a web-based survey, which included open-ended questions about their experiences with the advantages and pitfalls of VCs. A total of 2558 free-text answers were provided by 657 of the 1237 GPs who participated in the survey. The material was subjected to reflexive thematic analysis. Results Four main themes were identified. First, VCs are described as being particularly convenient, informative, and effective for consultations with previously known patients. Second, strategically planned VCs may facilitate effective tailoring of clinical trajectories that optimize clinical workflow. VCs allow for an initial overview of the problem (triage), follow-up evaluation after an in-person consultation, provision of advice and information concerning test results and discharge notes, extension of sick leaves, and delivery of other medical certificates. VCs may, in certain situations, enhance the GPs’ insight in their patients’ relational and socioeconomical resources and vulnerabilities, and even facilitate relationship-building with patients in need of care who might otherwise be reluctant to seek help. Third, VCs are characterized by a demarcated communication style and the “one problem approach,” which may entail effectiveness in the short run. However, the web-based communication climate implies degradation of valuable nonverbal signals that are more evidently present in in-person consultations. Finally, overreliance on VCs may, in a longer perspective, undermine the establishment and maintenance of relational trust, with a negative impact on the quality of care and patient safety. Compensatory mechanisms include clarifying with the patient what the next step is, answering any questions and giving further advice on treatment if conditions do not improve or there is a need for follow-up. Participation of family members can also be helpful to improve reciprocal understanding and safety. Conclusions The findings have relevance for future implementation of VCs and deserve further exploration under less stressful circumstances.

Suitability of issuing sickness certifications in remote consultations during the COVID-19 pandemic. A mixed method study of GPs’ experiences

“…In contrast, almost 60% found it unproblematic to extend a sickness certificate without physical attendance. This is in line with the findings of a recent Norwegian study on GPs’ experiences with video consultation [ 21 , 23 ]. The interviewed GPs confirmed that they would not issue a sickness certification without prior knowledge of the patient and the medical problem and thus found that remote consultations are particularly suitable for the follow-up of chronic and long-term diseases.…”

Patients’ experiences with receiving sick leave certificates via remote consultations in Norway during the COVID-19 pandemic: a nationwide online survey

“…GPs have raised concerns that video consultations might cause clinical uncertainty and lower the threshold for sick leave. 24 In contrast, the results from this survey showed that only 10% of the respondents thought that the GP would have obtained more information through an office appointment. The qualitative opinions indicated that the communication in remote consultations could be poorer due to loss of body language and unspoken signals, misunderstandings, under-communication and over-communication.…”

“… 23 24 At the same time, some GPs were concerned that video consultations might cause clinical uncertainty due to loss of valuable communicative information and lower the threshold for sick leave. 24 No research has been conducted on how patients experience receiving a sick leave certificate via remote consultations. The contact with healthcare providers, most often GPs, plays a role in preventing sickness absence or shortening sick leave duration.…”

Primary care gatekeeping during the COVID-19 pandemic: a survey of 1234 Norwegian regular GPs

“…Our study has added to the evolving literature about the role of primary care during the COVID-19 pandemic. 15 , 16 , 18 , 22 , 25 By international comparison, Norway had very low and even subnormal mortality rates during the pandemic. 26 This outcome has complex explanations, 26 as outlined in Box 2 and a Norwegian report on the pandemic from 2022.…”

“…Two articles about GPs’ reported use of video consultations have been published from the same material. 17 , 22 …”