Using Linguistic Ethnography to Study Video Consultations: A Call to Action and Future Research Agenda

Abstract

Video consultations are a rapidly growing service model, particularly in secondary care. Studies, mainly using trials and post-hoc surveys, have routinely documented that they can be a safe and effective means to deliver care at a distance. While video offers new opportunities to provide health services, it also constrains how patients and clinicians can interact, raising questions about feasibility, quality, and safety—questions that cannot be adequately addressed with prevailing methods and approaches. To support successful and appropriate implementation, use and spread of video consultations, we need to investigate how video changes the interaction. In this article, we use two worked examples to demonstrate how Linguistic Ethnography, a methodological approach combining ethnographic with linguistic analysis, enables a detailed understanding of how communication in video consultations works, providing an evidence base to support patients and clinicians with using this service model.

Communication in Telehealth: A State-of-the-Art Literature Review of Conversation-Analytic Research

“…The second subtopic entails studies that investigate how technology plays a role in the emergence and resolution of silences in healthcare encounters, particularly where they are treated by the participants as problematic (e.g., silences where talk should occur; Olbertz-Siitonen, 2015 ; Ruhleder & Jordan, 2001 ). In telephone (Chatwin et al, 2014 ) and video calls (Ilomaki et al, 2021 ; Nielsen, 2020 ; Seuren & Shaw, 2022 ; Seuren et al, 2021 ; Shaw et al, 2020 ), silences between turns are more likely to occur. In chat encounters, extended silences are normal while turns are being typed (Stommel & te Molder, 2015a , 2015b ).…”

“…Latency can cause participants to perceive silence where talk occurs. Patients seemingly have the primary right to continue, with clinicians producing repair strategies that concede the floor, but there is limited evidence on exactly who gets the right to talk when (Nielsen, 2020 ; Seuren & Shaw, 2022 ; Seuren et al, 2021 ; Shaw et al, 2020 ). While participants generally resolve these problems within a few turns (Seuren et al, 2021 ), Ilomaki et al ( 2021 ) show that in video-mediated group health counseling, participants may have different perspectives about the type of overlap that occurs and thus who has rights to talk, which may lead to diminished client participation.…”

“…Studies of video and telephone consulting investigate how participants conduct a physical examination despite this limitation. This work hones in on three interactional problems: (i) how to talk about the patient’s body as a clinical object (Heath, 2006 ; i.e., how it looks or feels) in a way that is understandable for the patient or their carer and relevant for the clinician (Lopriore et al, 2019 ; Seuren et al, 2024 ; Seuren et al, 2020 ); (ii) how to get the patient or their carer to feel the patient’s body in a clinically appropriate way (Lopriore et al, 2019 ; Pappas & Seale, 2010 ; Seuren et al, 2020 ; Stommel, van Goor et al, 2020 ); and, in the case of video, (iii) how to make the patient’s body visible (Due, 2022 ; Due & Lange, 2020 ; Pappas & Seale, 2010 ; Seuren & Shaw, 2022 ; Seuren et al, 2024 ; Seuren et al, 2020 ; Stommel, Licoppe et al, 2020 ; Stommel, van Goor et al, 2020 ).…”

“…Even where a healthcare professional is co-present with the patient, discrepancies in expertise between the co-present clinician and remote specialist can require tailored instruction sequences (Pappas & Seale, 2010 ). Video might be expected to be easier than telephone (or text), because it offers the additional affordance of visuality; however it brings with it the interactional problem of coordinating the patient’s body and the technology (Seuren & Shaw, 2022 ; Seuren et al, 2024 ; Seuren et al, 2020 ; Stommel, van Goor et al, 2020 ). Patient and caregiver have to consider whether to move the camera or the patient’s body (Due & Lange, 2020 ), a decision in which they invariably orient to the mobility of the technology as an affordance: a smartphone or tablet can be moved, Robodoc can move around, whereas a desktop camera is in a fixed position.…”

Exploring patient participation during video consultations: A qualitative study

“…Indeed, the theoretical concept affordances , 21 denoting the specific use potentialities made possible by different technologies, has seen little use in research on VCs. 22 In the context of product design, affordances are used to describe how an object may be perceived by an individual as affording certain uses. How a user may perceive and act upon an object depends on (1) the characteristics of the object and (2) the user's agentic use intentions as well as the user's preceding physical, cultural, and cognitive capacities.…”