The conventional arrangement of participants during video-mediated interaction stimulates dyadic interaction. This has implications for video consultations, as older patients in particular often rely on family members and/or caregivers who may now be excluded. We demonstrate how technology provides constraints and affordances and how that can affect quality of care.
Multiparty interaction in medical consultations is on the rise. Older patients in particular often rely on family members and/or caregivers for their day-to-day care, and these companions frequently need to be part of a clinical appointment. In parallel, video consultations are being pushed by policy makers, and are increasingly being used as an alternative to in-person consultations. In this paper, we examine the combined impact of these two developments: multiparty interaction (involving clinicians, patients and carers) and the conventional dyadic interaction of video consultations. Combining conversation analysis and ethnography, we use a corpus of 37 video-recorded video consultations in UK secondary care (cancer, heart failure, and diabetes) to: (i) demonstrate how technology affects the participation framework of the consultation, and (ii) examine two effects this has on the consultation, showing it can be both beneficial and detrimental to the quality of care. First, we demonstrate that in the conventional ‘talking heads’ arrangement of video interaction, it takes work to involve the companion: either the clinician has to explicitly address the companion, or the companion has to force themselves into the interaction. We then discuss how this potentially affects the quality of the consultation. Patients become more active participants in the consultation, which can lead to better health outcomes, but companions often also have a crucial role in the patient’s care and thus need to be part of the consultation. Our findings demonstrate that video technology has both constraints and affordances. Whilst video-mediated interaction can stimulate dyadic interaction (and offer a viable alternative to in-person consultations) such conventional arrangements place limits on multiparty interaction in video consultations, with companions potentially excluded from the talk. To make optimal use of video consultations, researchers need to investigate such constraints, and ways of addressing them, in order to preserve good quality of care.
