Comparison of face-to-face and telephone consultations in primary care: qualitative analysis

Background There is evidence that telephone consultations in general practice are typically shorter than face-to-face consultations and that fewer problems are presented in them. Aim To compare the communicative practices of doctors and patients in face-to-face and telephone consultations, in order to understand the contrasts between the two consulting modes. Design of study Conversation analysis. Setting Eight NHS GP surgeries in Scotland. Method Transcription and conversation analysis of 32 face-to-face and 33 telephone consultations. Participants Eighteen GPs and 65 patients. Results There are no underlying contrasts between the communicative practices used in face-to-face and telephone consultations. Telephone consultations are typically used by patients to deal with a limited range of single-issue concerns, whereas a wide range of different problem types is dealt with in face-to-face consultations. Most telephone consultations for new problems lead to a face-to-face meeting rather than a diagnosis, making them shorter than equivalent face-to-face consultations. Interaction in telephone consultations is continuous and orderly, but in face-to-face consultations there are periods of silence that facilitate the introduction of additional topics, including social speech and rapport building. Doctors on the telephone are less likely to elicit additional concerns than in face-to-face consultations, and ask fewer questions when patients present self-diagnosed problems or describe problems with treatment. Conclusion Doctors in general practice do not substantially change their communicative behaviour on the telephone. Telephone consultations are shorter and include less problem disclosure than face-to-face meetings, partly because they are typically mono-topical and partly because of intrinsic differences between the two channels.