1 Introduction

The demands on healthcare systems worldwide are increasing as populations increase and people live longer. Patient numbers and limitations on doctors’ time can restrict the level of in-depth or personalised information that patients can receive. This may relate to different options for treatment or long term management of chronic conditions. Further barriers to successful healthcare are patient’s lack of understanding of health conditions, finding out about new treatments, and awareness of on-going support to guide them.

Within the UK, there is a drive for more openness within healthcare, encouraging patient empowerment, integration of medical records and patient-centred care [1]. Issues such as ownership of a person’s health records and the ethical procedures of different groups handling medical information are important issues for this development. The rationale for these initiatives is that if patients had more information and understanding of their state of health, they would be able to take better control of their health which would generate better health outcomes, place fewer burdens on health services, and lead to more cost-effective healthcare services. Some authors have discussed how IT can enhance medical provider-patient relationships [2].

2 Methods of Study

In order to explore the topic of better patient-doctor communication, two studies were carried out. Firstly, a focus group was carried out with a group of 5 members of the public in their 50 s and 60 s. A number of topics were discussed relating to visiting the doctor. The aim was to obtain their views on and to identify and problems they faced. Secondly, a questionnaire survey was administered to a sample of 128 people. The aims of the questionnaire were to obtain patient opinions of online medical information in general, making appointments to see their doctor, and possible methods of communication with their doctor.

3 Results

3.1 Survey

The survey of 128 respondents included 57 males (44.5 %) and 71 females (55.5 %). The age distribution of the sample was 77 people aged 18–29 (60.2 %), 18 people aged 30–49 (14.1 %) and 33 people aged 50 and over (25.8 %), so the survey was oriented towards younger.

In terms of accessing medical information when experiencing medical symptoms, it was found that 46.9 % of respondents go online to seek information before consulting their doctor, 38.3 % make an appointment first, while others (11.7 %) do both at the same time (Fig. 1). One of the reasons that many people go online to find medical information is the ease and immediacy of accessing information from the Internet. This will be situation dependent and as one person said, “If the symptoms were serious or painful I would just make an appointment”.

Fig. 1.
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Survey: starting point to find out about medical condition

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Respondents were also asked for their opinion of online medical information and how helpful they found it. Their response was recorded on a Likert rating scale. It was found that 45.4 % of people considered it either ‘helpful’ or ‘very helpful’ while 30.5 % felt neutral about it. Others were less confident about online medical assistance, with 11 % rating it either ‘unhelpful’ or ‘very unhelpful’ (Fig. 2).

Fig. 2.
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Survey: helpfulness of online medical information

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Comments were also sought from participants on their experience or opinion of online medical information. Despite the high percentage that rated online information positively, most of the people who commented expressed reservations about the efficacy of this information source. A table of comments and their frequency are shown in Table 1.

Table 1. Comments on online medical information
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Some people stated that they wouldn’t necessarily take their information from a single source but would review a few different websites to look for consistency of information. There was also a requirement for sites to give more information about medications and their possible effects. In a comparison study of 3 online symptom checkers, usability issues were recorded for all 3 systems including relating symptoms to the options provided, the inflexible nature of the process and assuming knowledge that patients did not necessarily have [3]. Bol et al. provide advice on medical website design for older patients [4].

The survey asked about the ease of getting a suitable appointment time to see a doctor at the local GP practice. As Fig. 3 shows, while 34.4 % considered it either ‘very easy’ or ‘easy’, 45.3 % rated it as either ‘difficult’ or ‘very difficult’ (18 % were neutral). Common problems were: only being able to book an appointment to see a particular doctor several days or weeks in advance, and trying to get in on the day and possibly getting an appointment time that did not fit in well with their working hours. Table 2 lists the problems in booking an appointment and the frequency that they were mentioned:

Fig. 3.
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Survey: ease of getting a suitable appointment

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Table 2. Comments on appointment booking
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Respondents were asked how easy patients found it to talk to the doctor and to communicate their medical condition to them. As Fig. 4 shows, 68.8 % of the participants stated that communication was either ‘easy’ or ‘very easy’. 9.4 % of the sample experienced more difficulty and felt that patient-doctor communications was either ‘difficult’ or ‘very difficult’ (20.3 % were neutral). A number of comments were made that participants found GPs to be very easy to communicate with. One person stated: “I have never had any problems and am satisfied with the advice I have received.”

Fig. 4.
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Survey: ease of communicating with the doctor

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However quite a few participants did highlight communication problems, sometimes due to English not being their first language. Interestingly one comment was: “It is easy to communicate my condition but less easy to receive the advice. I sometimes forget what was said” and “Trying to be really clear about how things feel is difficult - sometimes the words don’t seem to cover it”. Regarding listening to the doctor’s advice, it was said that: “There can be a lot to take in with discussion of symptoms, diagnosis, treatment, next steps, contraindications, etc.”, and also: “It is not easy to understand the terminology from doctor. Sometimes I just lack the necessary medical vocabulary.” This might indicate that providing some kind of record for the patient to take away might assist them in understanding their condition better and reduce the need for them to return a make another appointment to seek clarification.

Some participants felt that due to the limitation on appointment times, they felt rushed which restricted their ability to ask questions or to be clear about the advice. It was said that: “The feeling of being rushed and an unclear outcome is also problematic”, and also: “I don’t think doctors always know what your condition might be or don’t want to jump to conclusions too quickly so often tell you to return if symptoms get worse”.

A further problem was that of seeing different doctors (a possible consequence of limited appointment availability) and having to explain their medical history each time. As one person said, “Seeing different GPs every time and explaining your medical history and what you’ve tried before (is a problem)”, and the difficulty of “…re-explaining your medical history to a new doctor and showing you have a medical condition”.

A key part of the survey was to ask participants whether they would be willing to use a range of methods for seeking medical advice as an alternative to traditional face-to-face communication. These included: telephone consultation, email, group session, video-communication and online forum. Figure 5 shows how many of the respondents would consider using each of these methods.

Fig. 5.
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Survey: interest in alternative methods of patient-GP consultation

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Phone: Telephone consultation with the doctor is a well-established method in the UK. 74.2 % of the respondents said that they would use this method of communication with a doctor and a number confirmed that they had already used it and were happy with it. The clear benefit of the method was that it was: “An easy way to talk to someone professional without having to leave the house”. Reservations about telephone consultations were: the difficulty of describing some symptoms over the phone and a concern that they may not be expressed properly. Others said that it would be hard to “Understand what the doctor’s saying without a face-to-face chat”. However it was thought to be less effective for conditions where the doctor should examine you directly. It was said that a telephone call would be a useful mechanism for: a results review, minor ailments and discussing ongoing or recurring issues. Interestingly one person stated that a telephone call could make the experience less intimidating.

Email:

There was less support for the idea of emailing the GP although 47.7 % stated that they would consider using it. A positive comment in favour of it was that the person could: “Think thoroughly about my problem or disease and explain it to them and reply carefully about my answers”. However it was also said by one person that it was too impersonal while another said that: “I probably wouldn’t trust it as much - might feel that it’s automated”. One person said that they would: “only use a telephone system with a GP who was known to me and I would very carefully explain my condition to avoid misinterpretation”. It was also said by one person: “I might have to wait a while for a response and if ill wouldn’t want to keep checking my emails”. Concern was also expressed that the information might not be confidential. Finally, as for telephone consultations, email would be suitable if: “No physical examination was necessary but could include images to indicate condition/injuries.” A service for electronic web-based consultation is eVisits. The authors report on an evaluation of its acceptance and its usability [5].

Group Consultation:

The idea of meeting as a group to discuss different medical conditions only received support from 23.4 % of participants. There were many reservations about this idea such as: embarrassment at talking or being examined in front of a group, possibly meeting someone they knew at the meeting, lack of confidentiality, and someone might take too much of the time. However for a group who had been diagnosed with a similar condition, a group meeting might be: “beneficial for gathering knowledge for treatment”. Group meetings were also thought to be more suitable for discussing chronic conditions. Other comments in favour of the idea were: “This might be good so we can share the experiences and methods” and “Communication is the best way to get more information”.

Skype or Video Consultation:

Here the patient would communicate with the doctor through a video link but on a one-to-one basis. This innovation has been tested where a video link has been put into a care home so that residents could seek the doctor’s advice without needing to travel to the surgery. Interestingly, 82 % of the participants said that they would be willing to use this method as a means of consultation. A Chi-squared test showed that a significantly higher proportion of those in the 18–29 age group were interested in using video or Skype communication compared to the other two age groups (p = 0.001). This is not an unexpected result given the familiarity of the 18–29 age groups with online face-to-face communication. The convenience of a video call was recognised by many participants as well as the advantage of instant feedback and face-to-face communication, making the consultation more personal. One respondent had seen a similar system in use on TV which had given them confidence in using such a system.

Forum:

An online forum would be organised by the GP practice for its patients with a doctor moderating the discussion. 45 % of respondents stated that they would use such a service. A positive comment in favour was “I am an online person and surfing a lot to find my answers. This could be a good way to find a solution”. It was thought that the forum could be most useful for disseminating general information about medical matters but that the forum would need to be carefully moderated. It was also thought that the event could become confusing if forum members had similar symptoms but different illnesses. The method would be more relevant if the medical condition being discussed was on-going rather than for transient ailments. Examples given of possible online forum topics were: nutrition, high blood pressure or diabetes.

3.2 Focus Group Results

The focus group session was conducted with a group of 5 members of the public aged 50 and over. Within the discussion, a number of problems emerged relating to: patient-doctor communication, patient information, diagnosis, decision making, medication and appointments. These are listed in Table 3 alongside some potential solutions. Some of these solutions are related to the different methods of GP consultation studied in the survey:

Table 3. Problems or issues arising from focus group and potential solutions
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While efforts are being made to achieve enhanced patient-doctor partnerships, good communication and transparency of process, the results from the focus group show that further improvements are possible.

4 Discussion

From the results of both studies it can be seen that there is scope to develop new methods to support better patient information and communication with their doctor through a number of different means including:

  • Implementing alternative methods of GP contact such as by email or video communication that could fit in better with peoples’ preferences, lifestyles and to support those who cannot easily travel to the doctor’s surgery.

  • Providing IT systems that give doctors a visual or graphical overview of the surgery’s patient population may be helpful. Such systems could highlight those with certain medical conditions who should be contacted when new information or a seminar is being offered. Such a system could also show those patients who have not seen a GP for a period of time and should be considered for being invited in for a check-up.

  • Offering new ways for patients to access information about themselves such as directly from the patient record. This service will become more common but there may still be barriers, particularly technical ones, to both patients and clinicians engaging with them [6].

  • Providing an application or facility that allows patients to come away from a doctor’s consultation within updated information about their condition would encourage them to learn more about their health, be able to discuss it with the doctor on a more informed basis and ultimately take more actions to improve it.

  • Offering medical forums moderated by a doctor could help people to learn more about their medical condition by posing questions through the forum and improving their knowledge about it.