Agency and the telephone: Patient contributions to the clinical and interactional agendas in telehealth consultations.
Sarah J White, Amy Nguyen, John A Cartmill
PMID 35074218WHAT IT FOUND
In 15 telephone consultations, doctors rarely offered patients a chance to raise extra concerns, yet patients often brought them up themselves, especially near the end.
Asking near the start and end may make this easier.
Key findings
01In 15 telephone consultations, doctors explicitly offered patients a chance to raise another concern in only two.
02Patients raised concerns or questions without being asked, and initiated transitions between consultation activities, even when doctors did not explicitly provide space.
03Patients could open a closing sequence to ask for clarification, or move from treatment planning back to diagnosis or problem presentation.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study analysed only 15 telephone calls from one Australian gastrointestinal clinic, so it cannot be generalised to other settings, specialties, or face-to-face care. Patients were a convenience sample who self-selected, and calls with support people or technical recording problems were excluded. The sample included only English-language calls, and visit types were mixed across three doctors. One doctor was an author, which may affect how interactions are interpreted. The study did not include patient or clinician interviews, post-visit surveys, or outcomes such as missed concerns, safety, satisfaction, or time. Patients with lower health literacy, language barriers, cultural differences, or age-related lower confidence were not represented, so they may struggle more.
Declared interests
The authors declared no conflicts of interest. One of the three doctors studied was an author and recorded three of the consultations.
The easy way to misread this
Do not conclude that asking patients about other concerns improves consultation quality or safety. The study observed 15 telephone consultations and did not test a communication intervention. Do not assume patients with lower health literacy, limited English, or less confidence will create the same space; those groups were not represented.