“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 cues. 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 a 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 care.