Box 2.

Counter-examples where video added value

The examples below show that some clinicians had used and valued the video format in situations where many interviewees had said it did not add significant value.

Out-of-hours care

Particularly in out-of-hours contexts (where pre-threshold probability of pathology was higher and level of risk greater), some GPs used video as an adjunct to telephone for rapid visual assessment (‘eyeballing’), especially for children. Video was also used for reassurance and following up problems that had not resolved: ‘I can see on their [parents’] faces whether they’ve been reassured by my description of why I’m not worried about their kid’s breathing etc. and I know whether I can leave it there or whether they’re going to end up needing to come in anyway.’ (GP interview [RBDGP-CH1])

Nursing homes

Video was deemed helpful for linking with nursing home staff to discuss complex patients [HFVC19-GPW], ‘eyeballing’ unwell patients, especially in the pandemic context where in-person visits carried a risk of reintroducing infections to vulnerable patients, and for statutory functions: ‘The times I use it [video] regularly is for nursing homes — it is legally required for me to see a patient to write a death certificate and it is now allowed to see them digitally.’ (GP interview [RBDGP-NL1])

Emergency assessment of very unwell patients

While video did not change management in most emergencies, it sometimes provided a crucial clue: ‘I could just see how breathless she was and I was counting her respirations on the phone and, you know, I couldn’t pick it up on the phone, I spoke to her first and said, “I think let’s do a video call”, and it was like “Gosh, she’s a lot more breathless than I realised.”’ (GP interview [RBDGP-EH1])

Talking a patient through self-examination

While remote physical examination was often unhelpful, one GP interviewee [RBDGP-KI1] reported a trainee picking up a case of appendicitis using patient self-examination on video.

Patients with mental health issues

While some patients with mental health issues strongly preferred in-person contact (see main text), some were much better able to access the care they needed by video: ‘So, to be able to know that I can just sit … be at home and still have that consultation, honestly it’s amazing, and thinking back to in the past when I used to suffer from mental health difficulties, I used to cancel quite a lot of my appointments because I didn’t want to go out.’ (Interview with patient (remote locality) [HFVC02])

Less experienced clinicians

Some trainees and early-career GPs or trainees, who were familiar and confident with new technology, reported using video, rather than telephone, to compensate for their limited knowledge of the patient and limited experience managing risk in general practice.

Chronic disease check-ups

Some nurses used video to help assess lifestyle and coping in chronic disease self-management: ‘You get a bit more from patients if you can actually see them as well. One [chronic disease review] that I did, the patient was having a cigarette while I talked to him!’ (Nurse interview [RBDPN-MS1])

Patients with communication challenges

All interviewees agreed that telephone was unhelpful for the hard-of-hearing and limited English speakers. Some felt that video could be a worthwhile alternative to in-person contact for such patients: ‘A video could be quite useful with language barriers because you can, you can kind of see the gesticulations and things like that a bit, a bit more easily, so I might do a video quickly if, if I wasn’t sure about the history. And I think you’d quickly see how much discomfort he would be in.’ (GP in clinician focus group [RBDFG1-R1])