“I can’t show them on the phone so it’s what I say and I’m not saying a lot.” – The loss of nonverbal and visual cues during telephone consultations, equity of access and the impact on marginalised patients: a qualitative study.

Background: There has been an increase in the use of telephone consultations in General Practice in the UK during and since the COVID-19 pandemic. This results in a reliance on verbal communication alone due to the loss of non-verbal and visual cue. The consequences of this for inequities of healthcare in marginalised groups is underexplored

This paper examines accounts of patients from marginalised groups of the impact of loss of non-verbal and visual cues during telephone GP consultations and effects on experiences of care.

Design and setting: Ethnography and interview study (n=15) undertaken at three sites in London: a foodbank, a community development organisation, and a drop-in advice centre for migrants. Additionally, GPs (n=5) working at practices in London, Digital Health Hub staff (n=4) and staff at fieldwork sites (n=3) were interviewed.

Method: Ethnographic observation (n=84hrs) and semi-structured interviews (n=27). Interviews were conducted in-person and over the phone and data were analysed through reflexive thematic analysis.

Results: Analysis identified challenges in effectively conveying information during telephone GP consultations as a result of language barriers, health literacy, and concerns around sensitive disclosure as a result of a loss of non-verbal and visual cues. Additionally, GPs reported mitigation techniques employed during telephone consultations including increased use of questioning, referrals for additional tests, and converting to face-to-face consultations in an effort to improve equity.