Social presence in telemedicine.

We studied consultations between a doctor, emergency nurse practitioners (ENPs) and their patients in a minor accident and treatment service (MATS). In the conventional consultations, all three people were located at the main hospital. In the teleconsultations, the doctor was located in a hospital 6 km away from the MATS and used a videoconferencing link connected at 384 kbit/s. There were 30 patients in the conventional group and 30 in the telemedical group. The presenting problems were similar in the two groups. The mean duration of teleconsultations was 951 s and the mean duration of face-to-face consultations was 247 s. In doctor-nurse communication there was a higher rate of turn taking in teleconsultations than in face-to-face consultations; there were also more interruptions, more words and more 'backchannels' (e.g. 'mhm', 'uh-huh') per teleconsultation. In doctor-patient communication there was a higher rate of turn taking, more words, more interruptions and more backchannels per teleconsultation. In patient-nurse communication there was relatively little difference between the two modes of consulting the doctor. Telemedicine appeared to empower the patient to ask more questions of the doctor. It also seemed that the doctor took greater care in a teleconsultation to achieve coordination of beliefs with the patient than in a face-to-face consultation.