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There is a strong policy push for alternatives to face-to-face consultations in healthcare. Telephone consultations have been an option for years, and now remote consultations (using SkypeTM and similar technologies) are being piloted.

There are concerns about whether remote consultations are as good as face-to-face in all aspects. Early findings from studies of remote consultations suggest that they could have advantages (e.g. patients generally feel satisfied and many prefer consulting in the comfort of their own home with family around them), but that remote consultations are different (e.g. compared to the equivalent face-to-face encounter the overall length is shorter, and the flow of conversation is different).

We need to know more about how the dynamic in the consultation changes when carried out via video-based communication tools.


This study aims to identify and analyse the communication strategies through which remote consultations are accomplished.


We combined data from two previous studies to give 37 video-recordings of video consultations (with diabetes, antenatal diabetes, cancer, and heart failure patients) and 28 face-to-face consultations, with consent from participants for further analysis. We used established research methods for the detailed analysis of interaction to identify the ways in which people communicate when they are conducting a ‘good’ video consultation.

Key Findings

We found three main challenges to conducting video consultations. First participants had to get the technology working and figure out how to start a video consultation. For routine consultations this went smoothly, but first-time consultations, particularly for patients less familiar with technology, just getting started took a bit of time. Second during the consultations participants are occasionally faced with technical issues that affected the flow of the conversation, such as poor audio/video quality or slow connections. Third conducting a good physical examination took additional work and required clear instructions. While it took slightly longer, participants generally are able to overcome these challenges.



Based on our research findings, we engaged with members of the public and clinicians to develop tailored guidance on how to have a good video consultation. This guidance will be made available through Barts Health NHS Trust. In addition, we are developing an animation for patients that will provide them with the necessary information in an easily accessible format. The design of this animation is also shaped in collaboration with members of the public through a series of workshops.

Animation workshop Animation Workshop 2

Conclusions and future plans

Video consultations can be a good option for some patients. They can overcome the interactional and technological challenges, but clinicians and patients will need support to do so. Training and guidance will be key to more widespread use in the NHS. We plan further work examining the feasibility and practicalities of physical examinations over video.



Are you interested in finding out more about the study, or remote consultations generally?

Do you have an interest in using or supporting the use of SkypeTM or similar media for clinical consultations?

For more information or to discuss the study, please contact Sara Shaw, Project Lead. 

This work presents independent research funded by the National Institute for Health Research (NIHR) under its Research for Patient Benefit (RfPB) Programme (Grant Reference Number PB-PG-1216-20012). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.

Further information:

Full project title:

Enhancing technology-mediated communication: qualitative analysis of remote consultations in cancer, diabetes and heart failure

Length of project:

June 2018 – August 2019








External collaborators:

Barts Health NHS Trust, London, UK:

  • Shanti Vijayaraghavan, Consultant Diabetologist
  • Satya Bhattacharya, Consultant Surgeon
  • Joanne Morris, Project Manager 


Virtual Online Consultations: Advantages and Limitations (VOCAL) study