1. Communication in Health Dr Fraser Reid, Prof Judy Edworthy, Dr Elizabeth Hellier Department of Psychology, University of Plymouth

2. Teleconsultations: Some psychological implications and hypotheses

3. IHSM Report 1998 ❙ Telemedicine technologies now proven ❙ Productivity gains and increased accessibility in healthcare delivery ❙ Changes in the way people work ❙ Loss of personal contact less important than expected

4. A failure of evaluation? ❙ Quality assessment based on clinical process and user satisfaction ❙ Too few studies of consultation process ❙ Most of these are based on retrospective surveys ❙ Known positivity biases in user satisfaction assessment

5. The consultation as social encounter ❙ Patient-centred model of care ❙ Patient satisfaction ❙ Adherence and compliance ❙ Health and clinical status ❙ Recall and understanding ❙ Psychological wellbeing

6. Does the medium matter? ❙ Media affordances ❙ Modality—Verbal or visual- verbal? ❙ Interactivity—Synchronous or asynchronous? ❙ Telephone consultations ❙ Email and texting ❙ Video links

7. The bandwidth hypothesis ❙ Interactive visual-verbal media will be best overall ❙ No—for information giving, interactivity matters, modality doesn’t ❙ No obvious advantage in adding vision to speech ❙ Failure of the videophone and poor prospects of 3G mobiles

8. The cognitive cueing hypothesis ❙ Non-visual media should disrupt conversation patterns ❙ No—people compensate with formal turn taking techniques ❙ Non-visual media should disrupt joint reference ❙ Yes—video provides listener feedback crucial to mutual understanding

9. The social cueing hypothesis ❙ Non-visual media will be less expressive ❙ Yes—phone calls are more task focussed and impersonal ❙ But—less inhibited online ❙ Non-visual media will disrupt decision making ❙ Yes—mutual agreement is harder to achieve online or on the phone

10. Some implications ❙ The medium matters—email, video or phone? ❙ A trade-off between improved access and reduced quality of care? ❙ Over-diagnosis and increased demand on the NHS? ❙ A less patient-centred service?

11. Warnings in healthcare

12. Alarms in the ICU and operating theatre ò Usual problems with alarms ❙ Too many ❙ Hard to tell apart ❙ Badly designed acoustically ❙ Not matched to situations

13. Alarms ò Research findings can be applied to ❙ Make warnings better acoustically ❙ Produce appropriate urgency ❙ Reduce numbers ❙

14. Visual warnings ❙ New cigarette warnings ❙ Design features e.g. font size, colour, borders ❙ Habituation ❙ Explicitness of message ❙ Education about risks

15. Compliance with warnings ò Must be seen as cost/benefit analysis ò Costs: ❙ time, money, effort ❙ adverse effects ❙ social effects

16. Recent research results ò Pesticide labelling ò Personal pronoun use ò Locating safety information within product instructions ò Differences for amateurs and professionals