Patient perceptions of empathy in primary care telephone consultations; a nested qualitative study

Problem

The use of telephone consultations in primary care has increased significantly during the Covid pandemic. A big challenge faced by medical professionals is to establish meaningful communication with patients during remote consulting. Empathic communication is valued by patients and can improve satisfaction with management, quality of life and pain outcomes. However, evidence for its effectiveness has focused around face-to-face interactions. Uncertainties remain about how doctors can express empathy without non-verbal communication, and how it is perceived by patients in primary care consultations.

Approach

We planned a feasibility study of our rigorously developed brief online training for primary care practitioners in empathic and optimistic communication (Empathica). The onset of the Covid pandemic required rapid adaptation of the trial protocol. To evaluate our feasibility process and outcome measures we used social media to recruit patients who had a recent primary care consultation. Measures were completed online and patients took part in telephone qualitative interviews. Interviews were transcribed and analysed through inductive thematic analysis.

Findings

302 patients completed outcome measures and 30 took part in a qualitative interview. Patients perceived that PCPs expressed empathy through their demonstration of genuine interest, concern, and reassurance. However, some perceive less social talk and rapport in telephone consultations, and many report that PCPs lack prior knowledge of the patient history. Patients felt their concerns were elicited through thorough questioning, seeking their expectations, being prompted for more detail, and being allowed to tell their story. However, patients missed the visual cues to know when to stop talking and interruptions were common. Patients felt listened to, through PCPs responding appropriately and summarising their concerns. PCPs often gave clear instructions for future treatment or management plans, although confusions and misunderstandings occur.

Consequences

Telephone consultations were acceptable to patients in the Empathica feasibility study, and PCPs were perceived to express empathy. The lack of visual cues can affect communication, but this is countered by PCPs putting more emphasis on their verbal responses and summaries. Patients felt listened to, acknowledged, and were generally satisfied with telephone consultations, but further work is needed to determine whether these views and perceptions are retained after the lifting of the Covid restrictions.