Patient-nurse-doctor interaction in general practice teleconsultations--a qualitative analysis.

We analysed the interaction in doctor-nurse-patient teleconsultations in primary care. A qualitative analysis was performed of 30 primary care teleconsultations in northeastern Finland. The male doctor was the same in all consultations. One of the trained nurses appeared in 27 consultations. The analysis followed the methodological principles of the grounded theory approach. The interaction in the doctor-nurse-patient triad was complex. The doctor had to concentrate on many things at the same time and undivided attention to the patient was not always possible. The nurse assumed an active role and was a facilitator of the interaction, an advocate for the patient, a secretary for the doctor and a mediator of the doctor's therapeutic influence. The patients frequently turned to the nurse for information. The role of interpersonal dynamics in telemedical encounters is important. Both the doctor and the nurse need to learn new skills to perform teleconsultations jointly.