Interaction Patient/Provider, Sensory Work and Telemedicine

The use of telemedicine for patient consultations has been increasing to provide care to remote populations, minimize travel costs and reduce wait times, among others (Ontario Telemedicine Network, 2019). One particular challenge of patient/provider communication in this context that needs further investigation concerns the sensory dimensions of clinical practice, since providers conduct physical examinations and establish a diagnosis without direct access to a patient’s body (Oudshoorn, 2008; Maslen, 2017; Lupton & Maslen, 2017). The objective of our study, conducted in partnership with the medical simulation centre of a large university-affiliated hospital in Ontario, was to describe how « the sensory work of medical decision-making » (Maslen, 2016) is accomplished during videoconferencing consultations.

To address the methodological challenge of making sensory work visible (Maslen, 2017), we combined video recordings of consultations (Heath et al., 2010; Iedema et al., 2006) with self-confrontation interviews (Mollo & Falzon, 2004). We recorded 10 post-orthopedic surgery visits with a standardized patient accompanied by a nurse. Immediately after each visit, physicians (5 surgeons and 5 residents) watched and commented their video-recordings. Thematic analysis of the interviews revealed two ways of accomplishing sensory work at a distance: (a) the constitution of a diagnostic space by moving the camera and engaging the bodies, and (b) the distribution of embodied practices to sense-at-distance. Video-based interaction analysis of the visits was then conducted to examine these practices in more detail, and showed that interactions between the physician, the patient, and the nurse are at the centre of sensory work in telemedicine.

The diffusion of telemedicine in hospital increases pressure to develop specific training programs for physicians, medical students, and other clinicians using telemedicine as a medium for providing patient care (Sharma et al., 2019). Some challenges related to affective distance, remote body, and the transformation of sensory perceptions increase the lack of confidence about clinical diagnosis. However, most online training programs focus on technological skills, but communication and relational skills are fundamental to put patients at ease and confident. There is a gap in the development of online training programs focused on these skills. Based on the results of our study, we co-design – in partnership with the simulation lab – an online training program that cover two sets of skills: (a) relational skills to establish a sense of connectedness with the patient and (b) communication skills to compensate for the lack of physical contact.

Publications et Conferences:

[1] Cherba, M., Grosjean, S., Bonneville, L. (2019). Using interaction analysis of medical simulations and self-confrontation interviews to understand sensory work in telemedicine, Qualitative Health Research Conference, 23-25 October, 2019, Vancouver, BC, Canada.

[2] Grosjean, S., Matte, F. (2019). Interaction patient/médecin à distance et « travail sensoriel » : de la « mise en mots » à la « mise en ordre » des sens lors de consultations en télémédecine. Actes du colloque International de Didactique Professionnelle, Organisé par l’Association RPDP en partenariat avec l’Université de Sherbrooke, 23-25 Octobre, Longueil, Québec.

[3] Grosjean, S., Nahon-Serfaty, I., Bonneville, L., Waldolf, R., Cherba, M., Boileau, J. (2019). L’espace diagnostic de la téléconsultation : De l’observation du ‘travail sensoriel’ à l’émergence d’un ‘Sensory ordering’ pour soutenir la décision clinique, Conférence 5 Juillet 2019, Université de Nice Sofia Antipolis, GREDEG, France.

Note: Project funded by Knowledge Institute Montfort (ISM)

Contact: sylvie.grosjean@uottawa.ca

Keywords Clinical Decision Making, Patient/Physician interactions, Sensory Knowledge, Simulation Lab