How do patients and general practitioners in Denmark perceive the communicative advantages and disadvantages of access via email consultations? A media-theoretical qualitative study

Abstract

ObjectiveEmail consultations have become part of everyday doctor–patient communication in many countries. The objective of this study is to investigate how patients and general practitioners (GPs) perceive the communicative advantages and disadvantages of access via email consultation drawing on a media-theoretical perspective.DesignWe analysed qualitative interview data from general practices in Denmark to identify salient themes.ParticipantsOur data set consists of semi-structured interviews with 30 patients and 23 GPs. The data were collected from February 2016 to September 2019.ResultsThe following themes emerged: (1) lower contact threshold, (2) accessing a new interaction space and (3) access to access. From the patients’ perspective, email consultations provided more convenient contact with their GP. From the GPs’ perspective, email consultations facilitated contact with patients whom they otherwise rarely saw, but also resulted in overuse and inappropriate use. Patients and GPs considered email consultations as inviting new interactions, facilitating also communication about emotional and sensitive issues. Both patients and GPs experienced email consultations as a way in which patients could achieve easier access to face-to-face consultations (access to access).ConclusionDrawing on a media perspective, this study adds knowledge of how the potentials of the medium of email consultations are perceived by GPs and patients. Email consultations do not simply extend existing forms of contact and consultation (face-to-face and telephone); they produce a new communication space with its own possibilities which result in new practices. With increasing use of email consultations, there may be challenges involved in transferring GP–patient communication to the written medium.

Not just an information-delivery tool. An ethnographic study exploring Danish GPs’ perspectives on and experiences with the relational potential of email consultation

“…A decade later, the use of email consultation in Denmark has rapidly increased from 1.3 million consultations in 2008 to 7.2 million consultations per year in 2018, corresponding to 21% of all GP consultations whereas the telephone consultation volume has decreased from 14.3 million in 2009 to 9 million in 2019 [ 15 , 16 ]. The increase in email consultations might result from the mandatory nature of email consultation (the GP must answer the patient within a maximum of five working days) and from overall demand from patients who value convenient, round the clock, untriaged access to the GP [ 17 ]. Furthermore, Denmark is one of the countries in the world that for many years has been the first and fastest to invest in digitalization, and where citizens, businesses and the public sector have been seen to exploit the opportunities more than in other developed countries [ 18 ].…”

How to conduct written online consultations with patients in primary care

“…Arrangements for written online consultation vary between different countries and healthcare providers. In Denmark, offering patients email consultation has been mandatory in general practice since 2007, and 21% of all consultations were conducted this way in 2019 5. In England, general practices have been encouraged by NHS England and NHS Improvement to adopt online triage platforms.…”

“…There are many similarities with other forms of communication. For instance, we suggest writing in the tone that you would normally use with the patient 526…”

Hybrid presence: Integrating interprofessional interactions with digital consultations

“…Current studies (Assing Hvidt et al, 2020;Fage-Butler & Jensen, 2015;Grønning, 2016;Grønning et al, 2020;Laursen et al, under review) have described advantages and disadvantages of digital consultations pertaining to the medium's technological features, analysed the content of digital consultation correspondences, and discussed mediated relational aspects of patient-doctor dyads. Though, while these studies provide important insights of phenomenological value, little is known about how digital consultations condition social interactions when they are used, produced, and interpreted in practitioner-practitioner dyads as an embedded part of the practitioners' everyday working life.…”