Elisabeth Assing Hvidt

Recent studies indicate that large language models outperform humans in empathic performance within text-based healthcare communication. Yet, promoting automated empathy risks fostering “empty empathy talk”—language devoid of relational depth and embodied meaning. Uncritical reliance on automated empathy may weaken clinicians’ empathic skills and impair relational quality in patient care, underscoring the need to safeguard authentic empathy in future healthcare through reflective strategies.

Introduction: The objective was to synthesise existing qualitative research on patients’ experiences and perspectives regarding medicinal cannabis and cannabis-based prescription medications. Content: A systematic search of EMBASE, Scopus, PubMed, and the Cochrane Library identified peer-reviewed articles. Characteristics and findings were organised using a predesigned data charting form. Thematic analysis identified key themes. Reporting followed PRISMA-ScR guidelines. Summary: From 849 records, 40 met inclusion criteria. Themes highlighted therapeutic potential and tolerability across various conditions. Patients described diverse administration methods and dosing strategies tailored to individual needs. Barriers included stigma, high costs, and bureaucratic delays in access and reimbursement. Facilitators involved support from healthcare providers, family, peers, and communities. Patients expressed a need for more education, information, and research. Many viewed prescription cannabis as superior to conventional medicines, though concerns about safety persisted. Outlook: A gap exists between generally positive patient-reported experiences and the cautious stance of the medical community, which calls for more definitive research. Patients often face stigma and bureaucratic hurdles, though support from physicians and social networks can ease access. Views on safety and effectiveness vary, as some see medicinal cannabis as natural and safe, while others remain sceptical.

Background: Acute respiratory infections (ARIs) are frequent reasons for medical consultations in general practice and can lead to unnecessary recontacts. Introducing new point-of-care (POC) polymerase chain reaction (PCR) diagnostic equipment may offer an attractive and efficient way of providing a more precise and exact microbial diagnosis. Successful uptake of POC PCR equipment could potentially lead to a reduction in recontacts with benefits for both staff and patients. However, introducing new diagnostic technology is a complex intervention and several contextual factors may impact the implementation. Objective: This study aims to evaluate the effect of POC PCR test availability in general practice on the subsequent (1) number of recontacts to the general practitioner (GP) for patients with symptoms of ARIs (primary outcome) and (2) hospital admissions, deaths, antibiotic prescriptions, health-related quality of life, GP and patient satisfaction, costs, cost-effectiveness, and contextual facilitators and barriers conditioning the implementation process (secondary outcomes). Methods: This study is a cluster-randomized, crossover, nonblinded superiority trial with a 1:1 allocation ratio between usual care (control) and POC PCR test availability (intervention). Questionnaire data are collected at day 0, 7, 14, and 28 after the initial contact (health-related quality of life, absenteeism and presentism among patients, and patient satisfaction) and after finalization of the study period (GP satisfaction). Data on recontacts, hospital admissions, redeemed antibiotic prescriptions, costs, and deaths will be retrieved from the Danish national registries. The implementation process will be evaluated based on data from interviews with users of POC PCR tests (i.e., GPs, staff, and patients) and from observations in the clinics in line with Medical Research Council guidelines. Results: As per the randomized crossover design carried out during September 2023 to March 2024 investigating a sample of 100 GP clinics, we expect to obtain an in-depth and multifaceted understanding of the effects of the availability of the POC PCR test equipment in general practice. Conclusions: This study will provide valuable information about the diagnostic conditions and possibilities in general practice and provide insights into the organization of primary health care. Trial Registration: ClinicalTrials.gov NCT06120153; https://clinicaltrials.gov/study/NCT06120153 International Registered Report Identifier (IRRID): DERR1-10.2196/72842

Objective: In this case study conducted in a Danish general practice, we aimed to explore how patients with obesity experience a novel treatment approach: group consultations (GCs) for weight loss, lifestyle changes and semaglutide treatment. To receive semaglutide treatment, patients were required to participate in GCs focused on lifestyle changes. Design: A qualitative study design comprising individual, semistructured interviews was used. Patients were asked to reflect on and describe their past experiences with participating in GCs. Thematic analysis was used as an analytical strategy. Setting: A general practice located in a larger city in the Region of Southern Denmark. Participants: 12 patients (eight women and four men) with obesity, aged between 27 years and 69 years, who met the Danish obesity treatment criteria for semaglutide (body mass index over 30 kg/m ² or over 27 kg/m ² with comorbidities), were included. Data were collected from 1 November 2023 to 31 January 2024. Results: Before attending GCs, patients were worried about sharing personal information with other patients and losing their confidentiality. They also feared being judged by the others in the group, possibly due to previous experiences of stigmatisation. However, after participating in GCs, patients reported positive experiences with peer sharing, had no issues with confidentiality and found the consultations beneficial. Most patients indicated a preference for GCs over one-on-one consultations in the future. Conclusions: Despite initial concerns about confidentiality and stigmatisation, patients ultimately had positive experiences and gained valuable peer support during group GCs in general practice. Various aspects of the group design, such as the hybrid consultation format and the role of the facilitator, may impact the effectiveness of peer support and influence patients’ overall experience of GCs.

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? 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. 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. 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.

Prior to the COVID-19 pandemic, the use of video consultation was largely confined to enthusiasts and the private sector. Private providers offered fee-per-consultation in primary care in the UK and Sweden, and had even taken on a small number of English¹ and Swedish general practices.² The Scottish health system was an outlier as it attempted to meet the needs of remote communities with a national video consulting programme.³ Elsewhere in Northern Europe, systematic integration within health services was rare. This changed with the onset of the COVID-19 pandemic, when video was seen as a way of augmenting the limited information received on telephone consultations and providing safer remote care. Across a range of nations, video consulting was rapidly adopted, but, as lockdowns eased and health services returned to a new normal, video usage declined whereas telephone use remained high.⁴

Video consultations represent a relatively new way of delivering face-to-face consultation in the context of general practice. The aim of the present analysis is to examine how video consultations influence patients’ experiences of their ability to communicate their emotions, needs, and vulnerabilities, as well as their experiences with their general practitioner’s ability to respond to these. The empirical base consists of 43 semi-structured interviews with patients (23 women and 20 men), aged between 17 and 81 years old, who have used video consultation as part of their treatment for various health issues in general practice. Emmanuel Levinas’ theory of the face was used as an analytical and interpretative tool. The analysis showed that in video consultations, patients experience a digital obscuring of the face, i.e., of their emotions, needs and vulnerabilities. This complicates the GP’s ability to perceive their vulnerability, making it challenging to recognize the patients’ needs. Moreover, this obscuration hinders the patients’ capacity to connect to their own vulnerabilities, which can lead to a diminished awareness of their own suffering. However, this mechanism might help patients who wish to obtain shielding from their face and from difficult emotions. Overall, we argue that significant relational and ethical dimensions of care within the doctor-patient relationship in general practice may be challenged in video consultations. We propose integrating Buber’s dialogical principles with the present Levinasian analysis as it may offer a promising approach to enhancing relational and ethical dynamics in video consultations.

BACKGROUND Acute respiratory infections (ARIs) are frequent reasons for medical consultations in general practice and can lead to unnecessary recontacts. Introducing new point-of-care (POC) polymerase chain reaction (PCR) diagnostic equipment may offer an attractive and efficient way of providing a more precise and exact microbial diagnosis. Successful uptake of POC PCR equipment could potentially lead to a reduction in recontacts with benefits for both staff and patients. However, introducing new diagnostic technology is a complex intervention and several contextual factors may impact the implementation. OBJECTIVE This study aims to evaluate the effect of POC PCR test availability in general practice on the subsequent (1) number of recontacts to the general practitioner (GP) for patients with symptoms of ARIs (primary outcome) and (2) hospital admissions, deaths, antibiotic prescriptions, health-related quality of life, GP and patient satisfaction, costs, cost-effectiveness, and contextual facilitators and barriers conditioning the implementation process (secondary outcomes). METHODS This study is a cluster-randomized, crossover, nonblinded superiority trial with a 1:1 allocation ratio between usual care (control) and POC PCR test availability (intervention). Questionnaire data are collected at day 0, 7, 14, and 28 after the initial contact (health-related quality of life, absenteeism and presentism among patients, and patient satisfaction) and after finalization of the study period (GP satisfaction). Data on recontacts, hospital admissions, redeemed antibiotic prescriptions, costs, and deaths will be retrieved from the Danish national registries. The implementation process will be evaluated based on data from interviews with users of POC PCR tests (i.e., GPs, staff, and patients) and from observations in the clinics in line with Medical Research Council guidelines. RESULTS As per the randomized crossover design carried out during September 2023 to March 2024 investigating a sample of 100 GP clinics, we expect to obtain an in-depth and multifaceted understanding of the effects of the availability of the POC PCR test equipment in general practice. CONCLUSIONS This study will provide valuable information about the diagnostic conditions and possibilities in general practice and provide insights into the organization of primary health care. CLINICALTRIAL ClinicalTrials.gov NCT06120153; https://clinicaltrials.gov/study/NCT06120153 INTERNATIONAL REGISTERED REPORT DERR1-10.2196/72842

In this study, we examine how Danish general practitioners (GPs) and general practice staff have fitted their use of video consultation to align with their conceptualisations of good care. Political stakeholders are repeatedly encouraging the use of video consultation in the healthcare sector, discursively referring to optimised use of healthcare resources, increased efficiency and flexibility for and geographical equality among patients. By the end of 2024, it will be mandatory for GPs to offer video consultations to patients in Danish general practice. This raises important questions about the implications of video consultation on the care provided in general practice. Our data consists of 30 semi-structured interviews with GPs and 132 hours of fieldwork conducted across seven clinics from August 2021 to August 2022. We analysed the data following the principles of reflexive thematic analysis and inspired by an abductive approach. Drawing on Annemarie Mol’s and Jeanette Pols’ conceptualisations of care and fitting, we identified common rationalisations articulated and observed in practice that highlight how fitting video consultation into the care provided in a general practice setting can enable (1) optimised use of busy patients’ time), (2) optimised use of clinician and clinic resources, (3) enhanced connection of ‘harder to reach’ patients and (4) better work experiences for GPs and staff. Our findings demonstrate the variety of video consultation use potentials, contributing to our understanding of the implications of video consultation on the provision of care.

Background: The purpose of this interview study was to explore patients’ and general practitioners’ (GPs’) experiences of space, time, and presence in video consultation in general practice in Denmark. Methods: The study included six GPs and seven patients from the Copenhagen area, with different experience of video consultations. The data consisted of semi-structured interviews with all participants including recordings from their video consultations. The transcribed interviews were analyzed by Interpretative Phenomenological Analysis (IPA). The theoretical analysis was inspired by philosopher K.E. Løgstrup’s writings about time, space, presence and sensation. Results: Both the patients and the GPs experienced a lack, or a different form, of presence in video consultations, comparing it to face-to-face consultations. Patients felt more secure in their own homes and the GPs found some of them to be more relaxed during the video consultation than in the face-to-face consultation taking place in the surgery. However, the consultation felt more superficial, with the GPs and patients experiencing an alteration in their sensory access to one another. The video consultation was also perceived as purpose-driven and action-oriented. Both patients and GPs felt that time was saved. According to K.E. Løgstrup, our experience is always composed of spatiality and temporality; the space is where we sense one another and experience duration, while time is the awareness of change and action. The theoretical analysis points to the experience of presence as spatial and, owing to the changed space in video consultations, the experience of presence and time is changed. Conclusion and Implications: The balance between space and time is altered in the video consultation. GPs and patients lack certain sensory impressions, owing to the changed spatiality. The changed spatiality, sensation and experiences of presence lead the participants to eliminate the expendable elements to make the consultation more efficient. Video consultations allow some issues to be handled quickly, but the option for physical consultations still needs to be available, as we believe we now can argue that the physical consultation room has importance for the experience of presence and time.