The impact of video-mediated communication on closed wound assessments in post-operative consultations: a conversation analytical study of video-mediated and co-present consultations.

Stommel, Wyke; van Goor, Harry; Stommel, Martijn

BACKGROUND Research on the use of video-mediated technology for medical consultation is increasing rapidly and accelerated by the COVID-19 pandemic. Most research in this area is based on questionnaires and focuses on long-term conditions. The few studies that focused on physical examination in video consultations indicated that it poses challenges for the participants. The specific activity of wound assessment through video in post-surgery consultations has never been studied yet. Also, comparative analysis of the face-to-face and video-setting on the moment-to-moment organization of such an activity is original. OBJECTIVE The objective of our study was to examine the impact of video technology on the workings of assessments of post-surgery wounds and its limits. METHODS We recorded 22 post-operative video consultations and 17 post-operative face-to-face consultations. The primary purpose of the consultation was informing the patient about the final pathology results of the resected specimen and the secondary purpose was checking on the patient's recovery, including an assessment of the closed wound. The recordings were transcribed in detail and analyzed using methods of Conversation Analysis. RESULTS The way in which an assessment of the wound is established in video consultations differs from the procedure in face-to-face consultations. In the consultation room, wound assessments overwhelmingly (15 out of 17) involve wound showings in the context of which surgeons report their observations formatted with evidentials ("looks neat") and subsequently assess what these observations imply or what can be concluded from them. In contrast, wound assessments in video consultations do not tend to involve showing the wound (3 out of 22) and, given the technological restrictions, do not involve palpation. Rather, the surgeon invites the patient to assess the wound, which opens up a sequence of patient and physician assessments in which diagnostic criteria like redness or swollenness are made explicit. In contrast to observations in regular consultations, these assessments are characterized by epistemic markers of uncertainty ("I think", "sounds… good") and evidentials are absent. Even in case of a potential wound problem, the surgeon may reside in questioning the patient rather than requesting a showing. CONCLUSIONS The impact of the video technology on post-operative consultations is that a conclusive wound assessment is arrived at in a different way compared to face-to-face consultations. In video consultations, physicians inquire and patients provide their own, "lay" observations, which serve as the basis for the assessment. This means that in video consultations patients have a fundamentally different role. These talking-based assessments are effective unless, in case of a potential problem, patient answers seem insufficient and a showing might be beneficial. The findings are expected to be generalizable to other healthcare areas, e.g., dermatology, physiotherapy. CLINICALTRIAL