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In the wake of the COVID-19 pandemic, video consultation was introduced in general practice in many countries around the world as a solution to provide remote health care to patients. It was assumed that video consultation would find widespread adoption in post–COVID-19 general practice. However, adoption rates remain low across countries in Northern Europe, suggesting that barriers to its use exist among general practitioners and other practice staff. In this viewpoint, we take a comparative approach, reflecting on similarities and differences in implementation conditions of video consultations in 5 Northern European countries’ general practice settings that might have created barriers to its use within general practice. We convened at a cross-disciplinary seminar in May 2022 with researchers and clinicians from 5 Northern European countries with expertise in digital care in general practice, and this viewpoint emerged out of dialogues from that seminar. We have reflected on barriers across general practice settings in our countries, such as lacking technological and financial support for general practitioners, that we feel are critical for adoption of video consultation in the coming years. Furthermore, there is a need to further investigate the contribution of cultural elements, such as professional norms and values, to adoption. This viewpoint may inform policy work to ensure that a sustainable level of video consultation use can be reached in the future, one that reflects the reality of general practice settings rather than policy optimism.

Background This theoretical paper aims to explore empathy in the context of technologically mediated patient-provider communication, specifically within the context of video- and telehealth consultations. Over the past few decades, empathy has been recognized as a vital component of high-quality patient care, often prioritizing the cognitive over the emotional dimensions of empathy. As healthcare increasingly embraces digital communication technologies, including video consultations, the dynamics of empathy in clinical encounters are altered. With this paper we explore the pertinent question: how do new digital communication modalities impact on empathy and its different dimensions? Methods To address the above question, we move beyond clinical and applied empathy frameworks instead integrating insights from two related philosophical traditions. First, the classical phenomenological understanding of empathy (represented primarily by Edith Stein) as embodied intuition. Second, the postphenomenological philosophy of technology, represented by Don Ihde and not least inspired by Maurice Merleau-Ponty’s phenomenology of embodiment. We apply these theoretical frameworks to empirical analyses of video consultations in general practice and telemedical encounters between chronic obstructive pulmonary disease (COPD) patients and specialist telenurses. Results Our analysis demonstrates that even though video consultations do not allow for the same level of “fine-tuned” body-mediated sensory input, a whole-body empathetic experience can nevertheless be established through (1) the audio-visual sensory impressions that are being mediated by the technology, (2) our whole-body interpretations of this information and (3) our shared experiences of a lifeworld that we actively orient ourselves towards. These experiences may lead to empathetic communication and helping actions that draw on both emotional, intuitive and cognitive dimensions in a holistic manner. Conclusion Combining theoretical insights from phenomenology and postphenomenology with empirical telehealth analyses, we demonstrate how empathy is both reconfigured through technological mediation and sustained as an embodied, intersubjective practice. We thus conclude that empathetic care practices can be established in technologically mediated encounters through bodily intentionality where our bodies and minds are unified in understanding and connecting with other persons, even though we are not in the same physical space. We propose a theoretical bridge, connecting classical phenomenology and postphenomenology in the context of empathy in technologically mediated patient-provider communication. This bridge is grounded in Merleau-Ponty’s conception of whole-body perception and the lifeworld whether through physical proximity or digital interaction.

ObjectivesThe overall study aim was to synthesise understandings and experiences regarding the concept of spiritual care (SC). More specifically, to identify, organise and prioritise experiences with the way SC is conceived and practised by professionals in research and the clinic.DesignGroup concept mapping (GCM).SettingThe study was conducted within a university setting in Denmark.ParticipantsResearchers, students and clinicians working with SC on a daily basis in the clinic and/or through research participated in brainstorming (n=15), sorting (n=15), rating and validation (n=13).ResultsApplying GCM, ideas were identified, organised and prioritised online. A total of 192 unique ideas of SC were identified and organised into six clusters. The results were discussed and interpreted at a validation meeting. Based on input from the validation meeting a conceptual model was developed. The model highlights three overall themes: (1) ‘SC as an integral but overlooked aspect of healthcare’ containing the two clusters SC as a part of healthcare and perceived significance; (2) ‘delivering SC’ containing the three clusters quality in attitude and action, relationship and help and support, and finally (3) ‘the role of spirituality’ containing a single cluster.ConclusionBecause spirituality is predominantly seen as a fundamental aspect of each individual human being, particularly important during suffering, SC should be an integral aspect of healthcare, although it is challenging to handle. SC involves paying attention to patients’ values and beliefs, requires adequate skills and is realised in a relationship between healthcare professional and patient founded on trust and confidence.

ObjectiveTo explore the experiences of Danish patients using video consultation (VC) to consult their general practitioner (GP) during COVID-19 lockdown and their attitudes towards continued use beyond COVID-19.DesignA qualitative design was employed, consisting of individual semi-structured interviews where participants were asked to retrospectively describe their experiences and reflections. Data were analysed using thematic analysis.SettingCapital and Southern Regions of Denmark.Participants27 patients (17 women and 10 men) aged between 23 and 76 years who had used VC once or more during the COVID-19 pandemic participated. The data were collected from February to October 2020. We used a convenience sampling technique and sample size was based on the principle of information power.ResultsThree overarching themes, each containing subthemes, were developed. Participants described pre-use reactions and concerns relating to VC as being ‘better than nothing’ given the COVID-19 circumstances, and preferred VC over a telephone consultation. Salient pre-use concerns related to whether the technology ‘would work’ and whether VC would influence consultation length and GP behaviour. Overall, participants reported positive experiences of VC use and communication attributing these mainly to ‘knowing the GP’ and ‘feeling seen and heard’. Participants were interested in future VC use for many needs as a natural consequence of an increasingly digitalised society, not least due to COVID-19.ConclusionsOur findings contribute with knowledge about first-user experiences of VC against the background of COVID-19. Participants showed positive attitudes towards future use of VC as either a supplementary or alternative consultation form in general practice.

Background Professional empathy has been associated with a range of positive patient- and clinician outcomes and is therefore considered important to develop for future physicians. Measuring changes in empathy scores among medical students by using the Jefferson Scale of Empathy (Student version) (JSE-S) has led to mixed results. So far, no investigation of Danish medical students’ empathy development has been conducted. The aim of this study was therefore to examine the associations between empathy scores among Danish medical students and medical school, year of curriculum, age, sex, co-habitation, and parental status, specialty preferences and motivations for choosing medicine as a future profession. Methods This was a cross-sectional questionnaire study. All medical students from four medical schools in Denmark in their first, third and sixth year ( N  = 4,178) were invited to participate in the study in October 2020. The associations between JSE-S sum score and the above explanatory factors were analysed by uni- and multivariable linear regression models. Results The JSE-S was completed by 672 medical students. The overall mean score was 112.7. There were no statistically significant differences in empathy between medical schools, first, third- and sixth- year medical students, age groups or parental status. Female students and students living with a spouse or partner scored higher on JSE-S than male students or students living alone, and the sex difference remained statistically significant in the multivariable regression. In both the univariable and multivariable setting, preference for future medical specialty was statistically significant, with a decrease in scores for students choosing surgery-specialties. Motivational factors were not statistically significantly associated with empathy, although there was a slight upwards trend for one of the motivational categories, named “personal experiences”. Conclusions Overall, our results showed neither decrease nor increase but instead rather stable empathy scores across years of curriculum of medical students in Denmark, adding to the mixed picture of empathy development among medical students. Our findings are consistent with positive associations found in international studies between empathy scores and higher age, female sex, specialty preferences for psychiatry and general practice and altruistic motivations for choosing to enroll. Although specialty preferences are changing during medical education, they may be used meaningfully as predictors of individual student empathy levels.

ObjectiveThe objective is to explore parents’ experiences with telephone contacts to out-of-hours primary care (OOH-PC) that include use of one-way video (video triage).DesignA qualitative interview study using Braun and Clarke’s thematic analysis approach.SettingOOH-PC in the Central Denmark Region.ParticipantsA convenience sampling strategy was used to include parents of young children (aged 1–5 years), who received video triage in OOH-PC: nine women and one man aged 31–42 years. Data were collected from 26 April to 23 May 2023.ResultsThree main themes were developed, each containing two subthemes: Theme 1. Video triage accelerates diagnostic clarity and prompt action, enhancing feeling of safety: Parents experienced that video triage provided faster diagnostic clarification than telephone triage. The visual assessment in video triage reduced uncertainties of describing symptoms and increased the parents’ feeling of safety. Theme 2. Video triage changed the communicative and relational behaviour: Parents found video triage impersonal as it focused on the physical examination. The conversation before activation of video was found important, as it established a feeling of trust and reassurance. Theme 3. Experiences of presence and involvement in video triage: Parents found their active involvement in video triage challenging, as it required divided attention and shared responsibility.ConclusionsOur study indicates the importance of paying attention to the changes in communication and consultation processes afforded by the implementation of one-way video triage. One-way video triage is experienced as a valuable tool for examination, yet it is also perceived to impair the building of trust in the patient–physician relationship.

ObjectivesRecent years have witnessed a progressive increase in defensive medicine (DM) in several Western welfare countries. In Danish primary and secondary care, documentation on the extent of DM is lacking. Before investigating the extent of DM, we wanted to explore how the phenomenon is understood and experienced in the context of general practice in Denmark. The objective of the study was to describe the phenomenon of DM as understood and experienced by Danish general practitioners (GPs).DesignA qualitative methodology was employed and data were generated through six focus group interviews with three to eight GPs per group (n=28) recruited from the Region of Southern Denmark. Data were analysed using a thematic content analysis inspired by a hermeneutic-phenomenological focus on understanding and meaning.ResultsDM is understood as unnecessary and meaningless medical actions, carried out mainly because of external demands that run counter to the GP’s professionalism. Several sources of pressure to act defensively were identified by the GPs: the system’s pressure to meet external regulations, demands from consumerist patients and a culture among GPs and peers of infallibility and zero-risk tolerance.ConclusionsGPs understand DM as unnecessary and meaningless actions driven by external demands instead of a focus on the patient’s problem. GPs consider defensive actions to be carried out as a result of succumbing to various sources of pressure deriving from the system, the patients, the GPs themselves and peers.

Uncertainties are omnipresent in health care, but little is known about general practitioners' (GPs) professional uncertainties concerning digital consultations. This is problematic, as many countries have undergone an extensive digital transformation. The aim of this study was to explore the professional uncertainties that emerged among Danish GPs with the introduction of video consultations. We conducted qualitative interviews with 15 Danish GPs during the beginning of the COVID-19 pandemic in 2020. The interviews were analyzed using an abductive approach. We identified 3 categories of uncertainty: integrity, setting, and interaction. Respectively, these 3 categories of uncertainty refer to (1) uncertainties related to how technology may impede the provision of health care; (2) uncertainties related to the potentials of video technology; and (3) uncertainties related to how the video consultation technology affects interactions with patients. The uncertainties experienced by Danish GPs appear to be a typical reaction to the introduction of new technology. Embedding video consultation technology into GPs' working routines will take time, and GPs do not necessarily feel intuitively capable of transferring their abilities, such as being good and socially present for video-mediated consultations. The heterogeneity of professional uncertainties experienced among the GPs suggests that they are the product of individual GP-technology relationships-not of the technology in itself. Consequently, we cannot expect that uncertainties can be remedied by changing or precluding new technology.

Background Clinical empathy has been associated with a range of positive patient- and clinician outcomes. Educating medical students to become empathic physicians has in recent years become a clearly pronounced learning objective in medical education in many countries worldwide. Research knowledge about how medical students experience the learning processes conveyed by empathy-enhancing educational interventions is lacking. Our study aimed to explore Danish medical students’ perspectives on which experiences allowed learning processes to take place in relation to empathy and empathic communication with patients. Methods We conducted a qualitative research study, involving semi-structured interviews with twenty-three Danish medical students across years of curriculum and universities. Braun and Clarke’s reflexive thematic analysis (RTA) guided the analytical process, moving on a continuum from inductive to deductive, theoretical approaches. Key concepts in regard to learning processes deriving from Amadeo Giorgi’s learning theory were applied to analyse the data. Results Learning processes in relation to clinical empathy occured: 1. when theoretical knowledge about empathy became embodied and contextualied within a clinical context 2. through interpersonal interactions, e.g., with peers, faculty members and clinicians, that conveyed behavior-mobilizing positive and negative affect and 3. when new learning discoveries in 2. and 3. were appropriated as a personalized and adequate behavior that transcends the situational level. Conclusion Rather than being an immediate product of knowledge transmission, skill acquisition or training, learning clinical empathy is experienced as a dynamic, temporal process embedded in a daily clinical lifeworld of becoming an increasingly human professional.

IntroductionThe term defensive medicine, referring to actions motivated primarily by litigious concerns, originates from the USA and has been used in medical research literature since the late 1960s. Differences in medical legal systems between the US and most European countries with no tort legislation raise the question whether the US definition of defensive medicine holds true in Europe.AimTo present the protocol of a systematic review investigating variations in definitions and understandings of the term ‘defensive medicine’ in European research articles.Methods and analysisIn concordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic review of all medical research literature that investigate defensive medicine will be performed by two independent reviewers. The databases PubMed, Embase and Cochrane will be systematically searched on the basis of predetermined criteria. Data from all included European studies will systematically be extracted including the studies’ definitions and understandings of defensive medicine, especially the motives for doing medical actions that the study regards as ‘defensive’.Ethics and disseminationNo ethics clearance is required as no primary data will be collected. The results of the systematic review will be published in a peer-reviewed, international journal.PROSPERO registration numberThis review has been submitted to International Prospective Register of Systematic Reviews (PROSPERO) and is awaiting registration.