Patients and general practitioners agree that wearing masks during consultations complicates physician--patient relationships: An exploratory, qualitative study.

BACKGROUND: The physician--patient relationship plays a critical role in the quality of primary care management. The generalised wearing of surgical masks in enclosed spaces - common during the COVID-19 pandemic -- could change the communication between patients and healthcare professionals. OBJECTIVES: To assess how general practitioners (GPs) and patients feel about wearing masks during a consultation and its influences on physician--patient relationship. To evaluate methods healthcare professionals could use to compensate for mask wearing during a consultation. METHODS: A qualitative study using semi-structured interviews based on a literature-based interview guide with GPs and patients in Brittany, France. Recruitment took place from January to October 2021 until data saturation. Two independent investigators performed an open and thematic coding and then discussed their results with a consensus procedure. RESULTS: Thirteen GPs and 11 patients were included. It appears that wearing masks complicates consultations by creating distance, impairing communication, mainly non-verbal and altering relationship quality. However, GPs and patients believed relationships were preserved, especially those with a solid foundation prior to the pandemic. GPs described having to adapt to maintain relationship. Patients worried about misunderstandings or diagnostic errors but saw the mask as a protective factor. GPs and patients described similar populations requiring vigilance, including geriatric and paediatric populations, and people with hearing impairments or learning difficulties. According to GPs, possible adaptations include speaking clearly, exaggerating non-verbal communication, temporarily removing mask while maintaining safe distance and identifying patients who need increased vigilance. CONCLUSION: Wearing masks makes the doctor--patient relationship more complex. GPs adjusted their practice to compensate.

Framing Public Opinion on Physician-Patient Conflicts on Microblog: A Comparative Content Analysis.

Introduction: Physician-patient conflicts in China have increased more than ten times from the 2000s to the 2020 and arouse heated discussions on microblog. The outbreak of the COVID-19 pandemic is believed to have brought a turnaround in the physician-patient relationship. However, little is known about the similarities and differences among the views of opinion leaders from the general public, physicians, and media regarding physician-patient conflict incidents on microblog, and whether the outbreak had an impact on this. Objective: This study aims to explore how opinion leaders from the physicians, general public, and media framed posts on major physician-patient conflict incidents on microblog, and compare the microblog post frames before and after the COVID-19 pandemic. The findings will provide more objective evidence of the attitudes and perspectives of the health professionals, general public, and media on physician-patient conflicts, and the influence of pandemics on physician-patient relationship. Methods: A comparative content analysis was conducted to examine the posts (n = 941) of microblog opinion leaders regarding major physician-patient conflicts in China from 2012 to 2020. Results: Post-pandemic microblog posts used more cooperation, positive and negative frames, but mentioned less health-related knowledge; no difference was found in the use of conflict and attribution frames. Results on the use of frames by opinion leaders from different communities found that the media used more conflict, cooperation, attribution, and positive frames, but used fewer negative frames and mentioned less health-related knowledge than general public and physicians. Results on the use of frames for different incidents found that incidents of violence against physicians used more cooperation, positive and negative frames and mentioned less health-related knowledge; in the contract, incidents of patient death used more attribution frames and mentioned more health-related knowledge. Conclusion: The physician and general public opinion leaders share some similarities in their post frames, implying that no fundamental discrepancy between them regarding physician-patient conflict incidents. However, the imbalanced use of frames by media microblogger would cultivate and reinforce the public perception of physician-patient contradictions. After the COVID-19 pandemic, more cooperation and positive frames were used in the posts, indicating an improvement in the physician-patient relationship in China.

Suitability of Video Consultations During the COVID-19 Pandemic Lockdown: Cross-sectional Survey Among Norwegian General Practitioners.

BACKGROUND: The COVID-19 pandemic imposed an acute, sharp rise in the use of video consultations (VCs) by general practitioners (GPs) in Norway. OBJECTIVE: This study aims to document GPs' experiences with the large-scale uptake of VCs in the natural experiment context of the pandemic. METHODS: A nationwide, cross-sectional online survey was conducted among Norwegian GPs during the pandemic lockdown (April 14-May 3, 2020). Each respondent was asked to evaluate up to 10 VCs. Basic demographic characteristics of the GPs and their practices were collected. The associations between GPs' perceived suitability of the VCs, the nature of the patients' main problems, prior knowledge of the patients (relational continuity), and follow-up of previously presented problems (episodic continuity) were explored using descriptive statistics, diagrams, and chi-square tests. RESULTS: In total, 1237 GPs (26% of the target group) responded to the survey. Among these, 1000 GPs offered VCs, and 855 GPs evaluated a total of 3484 VCs. Most GPs who offered VCs (1000/1237; 81%) had no experience with VCs before the pandemic. Overall, 51% (1766/3476) of the evaluated VCs were considered to have similar or even better suitability to assess the main reason for contact, compared to face-to-face consultations. In the presence of relational continuity, VCs were considered equal to or better than face-to-face consultations in 57% (1011/1785) of cases, as opposed to 32% (87/274) when the patient was unknown. The suitability rate for follow-up consultations (episodic continuity) was 61% (1165/1919), compared to 35% (544/1556) for new patient problems. Suitability varied considerably across clinical contact reasons. VCs were found most suitable for anxiety and life stress, depression, and administrative purposes, as well as for longstanding or complex problems that normally require multiple follow-up consultations. The GPs estimate that they will conduct about 20% of their consultations by video in a future, nonpandemic setting. CONCLUSIONS: Our study of VCs performed in general practice during the pandemic lockdown indicates a clear future role for VCs in nonpandemic settings. The strong and consistent association between continuity of care and GPs' perceptions of the suitability of VCs is a new and important finding with considerable relevance for future primary health care planning.

This Is My Body: A Reflection on Medical and Spiritual Distancing During the COVID19 Pandemic.

As sentient beings and as patients, clinicians, and Catholics, we long for touch and union. With COVID19, the distancing inherent during the pandemic manifests itself in medical and spiritual ways as we yearn to connect with our patients, our physicians, and the Eucharist. Summary: As sentient beings and as patients, clinicians, and Catholics, we long for touch and union. With COVID19, the distancing inherent during the pandemic manifests itself in medical and spiritual ways as we yearn to connect with our patients, our physicians, and the Eucharist. COVID19 distancing manifests in medical & spiritual ways as we yearn to connect with our patients, our physicians, and the Eucharist.

Integration of Technology in Medical Education on Primary Care During the COVID-19 Pandemic: Students' Viewpoint.

The COVID-19 pandemic has forced medical schools and clinicians to transition swiftly to working online, where possible. During this time, final-year medical students at King's College London, England, have received some of their general practice teachings in the form of virtual tutor groups. The predominant feature of such groups is online patient simulations, which provide students a valuable experience to help gain insight into current clinical practice amid the pandemic and inform how their practices as incoming junior doctors would continue. Even in the absence of face-to-face teaching and clinical placements, students have been able to hone their medical knowledge and soft skills through these virtual, simulated consultations. They have been exposed to a new consultation style while in a safe and collaborative learning space. Here, we explore how medical students have benefited from these virtual tutor groups and how similar small-group online teaching opportunities can add value to the medical curriculum in the future.

Virtual care: a 'Zoombie' apocalypse?

In the wake of COVID-19, clinicians took to telehealth to continue providing services to their patients, mostly via telephone or videoconferencing technology. Telehealth has many promised and proven benefits including convenience to the patient, potentially less distraction from the electronic health record (EHR), saves in travel time and expenses, and lowering patients' wait time in the clinic. However, there could be some unintended negative consequences including increased clinician burnout due to screen fatigue, potential loss of information due to the limitations of the medium, difficulty discussing sensitive issues and impacts on patient-clinician relationship, empathy, and compassion. In this perspective, we discuss some of the positives and potential negatives of telehealth and highlight some considerations that could guide the choice of media. We submit that for telehealth to become a sustainable solution that is widely applied, it is important to take these issues into consideration in both research and implementation of telehealth solutions.