Every gesture counts - research on communication in telemedicine at the University of Bayreuth
University of Bayreuth, Press release No. 094/2020, 15 June 2020
Restrictions during the coronavirus pandemic have highlighted the importance of video conferencing and telecommunications in the medical sector itself. Prof. Dr. Karin Birkner knows about the specific features of doctor-patient communication in telemedicine. She is Chair of German linguistics at the University of Bayreuth, and researches linguistic interaction and medical communication. Birkner has been working on telemedicine since 2015, with, among others, the "Tempis" stroke network of southeast Bavaria.
Prof. Dr. Karin Birkner, Chair of German Linguistics University of Bayreuth © UBT
What exactly is "medical conversational research"?
Conversational research is a method of empirical investigation into linguistic interaction. "Conversation" stands for various forms of authentic communication between people; ranging from lessons to gossip, telephone emergency calls to medical communication, everything that has to do with language and other means of communication is considered: gaze, facial expressions, gestures, etc. This also includes the question of how remoteness affects telemedical treatment.
Why is the conversation important when it comes to medical treatment?
Numerous studies show that the quality of the relationship between doctors and patients has an impact on the success of treatment, both positive and negative. Over the past decades, conversation skills have therefore become increasingly relevant in medical education. Conversation, whether mediated by telecommunications or face-to-face, is still regarded as the central medical instrument for diagnosis and therapy; however, the fee schedule for doctors remunerates it rather poorly.
To put it bluntly: If a doctor processes one patient in their practice every ten minutes and barely looks at them, or if they only talks t them on the phone - does that lessen the success of the treatment?
That is very exaggerated, because as always, differentiation is necessary. There are very different "occasions" for medical communication during any visit to the doctor. Some things can be resolved quite well remotely, while for other things, remoteness is obstructive or completely unsuitable. For example, the physical examination is dependent on physical presence. Doctors smell and feel a patient, trigger pain stimuli, control abdominal tension, observe gait, handshake, and skin temperature. Thus, for GP care in acute cases, communication mediated by telecommunication cannot become the rule. In some areas, however, e.g. in monitoring chronic diseases and injuries etc., telemedicine has undisputed advantages. And video is superior to the telephone call in the wealth of information it provides.
What communication hurdles are there in this area?
Since our research is still in progress, we can only say this much so far: It has already been shown in great detail that, in addition to the verbal cues, the eye plays an essential role in the smooth running of the process. In video transmission it is systematically altered, because, among other things, the camera has a fixed position or one cannot follow the gaze, for example, because only a section of the surroundings is visible, etc. Added to this timing.
In what way?
While we are listening, we are already analysing what we have heard so far and are already synchronously planning our next statement in order to then continue the dialogue as appropriately as possible. This is the only way to ensure that the contributions in a conversation switch back and forth without any pauses, but also without overlaps, like in table tennis. The smallest of delays are usually interpreted as meaningful. If the other party disagrees, a contradiction is flagged, or there has perhaps been a problem in understanding. The delays in the video transmission make this fine-tuning (more) difficult, because one never knows exactly whether the media transmission or the speaker's intention is causing the delay.
How exactly does remote examination work?
Just one example: We are dealing with the conversations between doctors and their patients via video, i.e. absent specialists and treating doctors with their patients in a very specific field, stroke diagnosis (see www.tempis.de). If a stroke is suspected, neurologists have to help determine, at very short notice, the cause of the stroke; however, they are not available 24 hours a day in every hospital in rural areas. Consequently, neurologists involved in the Tempis project in Munich-Harlaching and Regensburg are connected via video conference. In order to carry out the neurological tests, the local doctors act as the "extended arm" of the specialist during the examination. For example, they move their finger back and forth in front of the patient's face in such a way that the neurologists can see the patient’s eye movements via video and make a professional assessment.
So, this is about an interweaving of telemedicine and on-site medicine?
Yes, only a part of the treatment, namely the neurological examination, is done by video, and suitable assistants must be at hand. This assistance function does not always have to be assumed by a doctor - if one thinks of other cases, e.g. vertigo diagnosis, which Tempis also offers - but can also be taken on by an appropriately trained nurse when doctors are in short supply.
Where do you come in?
As conversational researchers, we are investigating, for example, how the three-way constellation - between patient, local doctor, and those connected via video – can be successfully managed by the participants. First of all, we are finding out what people have experienced themselves in times of coronavirus. In fact, it is surprisingly easy to adapt to the special features of this method of communication. The adaptations we make here, what exactly is particularly suitable, how misunderstandings can be avoided, and also what training content can be gained from this, is currently being researched.
What do telemedicine practitioners have to learn afresh?
When I asked the director of Tempis Dr. Gordian Huber about it, the first thing that came to mind was how to use the technique. But that's another thing that has been learned in times of coronavirus. With experience, it gets easier and easier, it happens quite fast! But the second field he mentioned is rather interesting, namely the question of how to best instruct assistants on site to perform exactly what is necessary for the neurological examination? This is, for example, a topic of our conversational research.
Is it possible to transfer these findings - advantages and disadvantages, approaches to video anamnesis, and remote care interviews - to other areas such as personnel management, teamwork, or school and study?
Absolutely! However, only in a general way; for detailed recommendations, conversational research would need empirical data from these fields of practice respectively.
Prof. Dr. Karin Birkner
Chair of German Linguistics
University of Bayreuth
Phone.: +49 (0)921 / 55-3610
Press & PR Manager
University of Bayreuth
Phone: +49 (0)921 / 55-5300