Patient-initiated video consultations: A qualitative study on reasons for patient-booking in Danish general practice

Abstract

Objective

This qualitative study explores when and why patients book video consultations through an online booking platform within the context of Danish general practice and how the technology affects patients’ use of this consultation type.

Methods

We conducted thirteen semi-structured interviews with patients from the same general practice who were experienced users of video consultations scheduled through the clinic's online booking platform. Interviews were analysed using thematic analysis and drawing on actor-network theory and Bruno Latour's concept of technical mediation as an analytical framework.

Results

We introduce the concept of “hybrid patients,” highlighting how values tied to video consultation that motivates patients to book them emerge through technical mediation in the network between patients, general practitioners (GPs) or practice staff, and the video technology. We identified three emerging values: efficiency, control and diminished presence. Video consultation affords efficient consultations that save patients’ time. It mediates patients’ sense of control when they experience certainty concerning their health issues. Video consultation mediates diminished presence that increases relational distance. However, it simultaneously allows for efficiency and emotional distance between patients and their GP, and between patients and their health issues.

Conclusions

When initiating the use of video consultation, the patient plays an active and conscious role in adjusting to the mediated values (efficiency, control and diminished presence) linked to this form of consultation. These emerging values are context-specific, and patients employ them based on their individual requirements. Patients trust their GPs to prevent severe or vulnerable topics from being discussed in a video consultation.

Introduction

This article explores when and why a purposively sampled group of Danish patients opt to book video consultations within the context of general practice.

The Danish healthcare system is financed through taxation and accessed by patients free of charge. General practice is the first point of contact for access to public healthcare. ¹ While an essential and integrated part of the system, general practitioners (GPs) act as private contractors and are paid according to the number of patients on their lists and the services they provide. Introducing video consultations in Danish general practice can be viewed as one of the more substantial digital changes made since the introduction of e-consultations in 2009. ²

Video consultation is a synchronous two-way audio-visual interaction between a patient and a GP or other member of practice staff. ³ Introduced in Denmark in 2020 as part of infection prevention during COVID-19, ⁴ video consultations in Danish general practice make up fewer than 2% of all consultations, and their use varies widely among individual clinics. ⁵ This variation may be due to the organisation of general practice, as clinics can decide for themselves how and when video consultations are used. Perceptions among GPs about the potential added value of video consultations, and thus their motivation to use the technology, differ, ⁵ which makes video consultation dependent on GPs’ local implementation efforts. Nevertheless, the official working agreement between the Organisation of General Practice and the Danish government states that GPs are required to make video consultations available to their patients by the end of 2024. ⁶ An explicit registration of how video consultations are initiated and by whom does not exist. GPs have reported that it is they or the practice staff who have initiated the conversation about video consultations with patients in person, by phone call, or in e-consultations. In some general practice clinics in Denmark, patients can book a video consultation with their GP through a secure patient portal, which is downloadable as an app, or they can use an SMS-based booking system.

From a political vantage point, the introduction of video consultations is part of the larger strategic aim of enhancing the digitalisation of the Danish healthcare system.^7,8 Video consultations aim to increase accessibility to healthcare independent of geography, increase efficiency and extend resources in Danish primary care. ⁵ This echoes earlier expectations that some scholars have named “promissory discourses,” meaning that digital healthcare promises to improve quality, use of resources and the accessibility of health services.^9–12

Existing international literature on patients’ satisfaction with using video consultation mainly points to convenience factors, such as reduced waiting times and travel costs for patients^13–16 and similar patterns have been identified within a Danish general practice context. ¹⁷

Another satisfaction factor identified as motivating patients to use video consultation is control. In a recent study, Grinfelde ¹⁸ argues that video consultation in healthcare can increase patients’ experience of control over clinical interaction by, for example, making patients feel less at risk. ¹⁸ According to Grinfelde ¹⁸ the patient is empowered by the ability to leave the digital consultation room more easily than in a physical consultation, thereby having more control in the asymmetrical relationship between patient and doctor.

The cited research often portrays patient-perceived benefits, such as efficiency and control, associated with video consultations as being separate from the technology–user relationship. ¹⁴ However, to better comprehend why patients choose video consultations, it is crucial to deepen our understanding of the interplay between technology and user and thus the dynamics within these technology–user relationships that influence patients’ decisions to book video consultations.

To that end, we use an actor-network theory (ANT) approach as an analytical framework to illuminate the intricate and minor reconfigurations and relation-making mechanisms between human and non-human actors when technology is introduced and used in new arenas. In this article, the perceived value of video consultations, which motivates patients to initiate their use, is approached as an outcome co-constituted by patients, GPs and video technology. This brings the technology into the equation as an equal and active partner. This article, therefore, explores the human and non-human interactions that take place when patients book a video consultation, and the emerging values that arise from experiences with video consultations in general practice. This knowledge is vital since the political move towards implementing video consultation in general practices intensifies the need for understanding patient motivations behind video use. Consequently, we ask the following research question:

When and why do patients book video consultations and how does the technology affect patients’ use?

Theoretical approach

Actor-network theory (ANT) is a continuously progressing set of theoretical tools and terms that share similar sensitivities towards material semiotics, ¹⁹ which is the perception of the world as consisting of networks of relations between human and non-human actors (e.g., physical material) that shape each other continuously. ²⁰ Actors as a term covers both humans and non-humans alike as ANT does not distinguish between the two types of actor. Actors’ inclusion in networks is based on the acceptance and relevance among other actors within the network.^21,22 ANT allows us to follow the practice of a heterogeneous network of human and non-human actors involved in set courses of actions, ²² such as booking and using video consultation in general practice.

We use Bruno Latour's perspectives on technical mediation to explore why and when patients book video consultations. Mediation is the process wherein multiple actors influence each other's aims and intentions. This interaction creates hybrid actors, illustrated in Latour's classic example of “the gunman.” Through the man's intention of harm and the gun's ability to extend that harm into murder, they become a hybrid actor with mediated intentions and abilities. ²³ In the case of video consultation, the hybrid actors involved are the patients, the practice staff or the GP and the video technology. With the patient as our point of departure for data collection, we will focus on what we refer to as the video-patient as we explore values emerging in the network between patients, practice staff or GP and video. We see video technology as different when used in consultations and patients as different when operating as video patients with mediated intentions and abilities. These emerging intentions and abilities that arise through technical mediation form part of patients’ reasoning for booking video consultations.

We use the ANT concept “black box” to describe a technical system with stabilised socio-material negotiations and settled disputes between human and non-human actors in the network. ²⁴ The mediating factors of technical elements can be difficult to register as they consist of stabilised negotiation. The black box concept comes into ANT as a metaphor for the box found in aeroplanes, which helps determine the reasons for aeroplane incidents. A black box is a system that is too technical to be transparent or understandable to the common person and it is, therefore, reduced uncontested to its function. ²⁴ In the present case of video consultations, the black box concept is used to highlight how structures that have stabilised over time (in-person primary care consultations) are being circumvented and disrupted by the introduction of new technology (online booking systems and medical consultations over video). This opens the door to a reconfiguration of the actors within the network of consultations between patients, GPs or practice staff and video technology.

Method

Data corpus

This study’s data corpus consists of semi-structured interviews with 13 participants (see Table 1 for participant characteristics) recruited from the same general practice clinic located in an urban area in Denmark.

Table 1.

A description of study participants’ characteristics.

Participant Pseudonyms	Gender	Age Range	Participant-Estimated Use of Video Consultations	Profession
Simon	Male	20–29	5	Student: healthcare
Emma	Female	60–69	3–6	Healthcare professional
Tobias	Male	30–39	10–15	Non-healthcare worker
Sarah	Female	50–59	5–7	Outside the workforce
Olivia	Female	20–29	5–10	Student: healthcare
Henrik	Male	60–69	10–15	Non-healthcare worker
Laura	Female	60–69	5–6	Non-healthcare worker
Sebastian	Male	30–39	3–4	Non-healthcare worker
Ida	Female	20–29	3	Student: healthcare
Sofie	Female	40–49	5–6	Healthcare professional
Nathan	Male	60–69	10	Non-healthcare worker
Ingelise	Female	50–59	10	Non-healthcare worker
Marie	Female	70–79	2	Outside the workforce

Since our aim was to include study participants with experience of self-booking video consultations online, we chose a clinic that offers patients this possibility as a way of consulting a GP or member of practice staff, in the knowledge that this is not yet a standardised option across the general practice in Denmark. The selected clinic has a high volume of video consultations (above the average across clinics in Denmark). At the point of data collection, the clinic had used video consultations regularly for 3.5 years.

In Danish general practice, there are two separate ways to access video consultation bookings: one through the use of the MyDoctor app, which is freely available to all patients; and the other through the use of an SMS-based solution that functions without the app. The selected clinic primarily used the app and all participants spoke from experiences of using the MyDoctor app.

Data sampling

Study participants were selected through purposive sampling, ²⁵ with the main selection criterion being a patient having used the self-booking online procedure (so that the video consultation was patient-initiated). To ensure that the study participants had a fresh recollection of the reasoning for their online booking, we recruited patients who had participated in a video consultation 4 weeks prior to recruitment or who had scheduled a video consultation within the coming 4 weeks. These criteria narrowed the potential participants to 13 patients who had booked online during the recruitment period. Recruitment was carried out in two rounds: eight patients in June 2023; and five patients in August 2023. The second round was initiated to secure the necessary information power as defined by Malterud et al., ²⁶ and thus, we were able to confirm data saturation and ample information power to support our research claims.

Recruitment

Study participants were first approached by their GP who described the project to them as an exploration of the use of video consultation, the motivations behind the patient's choice of consultation modality, and an exploration of which topics and conversations are suitable for video consultations according to the study participants.

For participants who agreed to take part, we sent them an official invitation and a consent form. This multi-phased process was intended to ensure minimal pressure to participate. Assuming that GPs have authority in their relationship with their patients ²⁷ the researcher stressed participation as completely voluntary several times. None of the invited study participants opted out during their dialogue with the first author. ²⁸

Data collection

We collected data through video interviews (nine) and phone interviews (four) all of which were carried out by the first author. Telephone interviews were used as backup if the technical aspects failed, or if the study participants preferred the telephone. From a research perspective, a preference for video interviews was promoted and video was used, when possible, to articulate some of the same processes and experiences that the study participants might have had when using video to consult with their GP.

All interviews were semi-structured, with a single interview guide. ²⁸ The emphasis in the interview guide was to promote the sharing of experiences of video consultation booking and use by study participants. By practising semi-structured interviews and focusing on concrete experiences with booking and using video consultation before, during and after the event we avoided simplistic reporting of motivation and convenience.

Before the interviews, all study participants signed an informed consent letter advising them that they could withdraw from the study at any time, that they were ensured pseudonymity, and their data would be handled according to the EU directive GDPR. All 13 interviews were audio recorded, lasted between 24 and 58 min, and were subsequently transcribed verbatim by the first author to secure coherent transcription of the verbal data. The study participants were pseudonymised through the transcription process, and identifying information was omitted from the transcript. All quotes used were translated from Danish by the first author, based on a dialogue among all authors.

Coding of data

The data were coded through computer-assisted qualitative data analysis software (Nvivo14). The data were coded with an abductive coding approach following the framework of thematic analysis. ²⁹ Abductive coding should be understood as deductive and inductive at times: the data were mainly treated inductively with emerging empirical themes but with a predetermined theoretical understanding of non-human actors having agency. The coding process led to the development of three themes: efficiency, control and diminished presence.

The three themes are presented as analytic points, discovering how values emerge from the mediation of video consultation. As a last clarifying detail, it is important to point out that in the clinic all these patients are connected to both GPs and practice staff, who video consult with patients. The data, therefore, includes experiences from booking and using video consultation with both GPs and practice staff, including nurses and health and social care assistants.

Results

Emerging efficiency

Efficiency, especially concerning saved time, was highlighted as a value tied to video consultation. The types of time savings mentioned by participants were saved travel, waiting and consultation time. Thus, time saved on different levels stood out as a dominant reason for wanting to book a video consultation. One participant explained:

I actually think that my main reason (for booking a video consultation) is simply the time perspective, I continuously return to. I think it's a huge advantage that it doesn't take any time, neither mine nor my doctor's, (…) I think she allocates less time [to video consultations]. So, I think that it is the time perspective that is quite important. (Emma)

In the excerpt above, Emma assumes that introducing video consultation in the clinic has changed the way her GP organises her time, communicating the belief that the GP allocates less time for a video consultation compared to a face-to-face consultation. In line with Emma's experience, a commonly held impression among participants was that a video consultation was shorter and more focused than face-to-face consultations. Interestingly, the vast majority of interviewed participants did not ascribe the efficiency of the video consultation to either themselves, the practice staff, or the GP. Simon has another way of framing video consultations:

…of course my doctor asks me “how are you?” But I feel we pretty quickly get to the point that we need to talk about [on video]. Not that I have small talk with my doctor on a daily basis, but I think it's a little bit more effective somehow. (Simon)

Simon experiences video consultations as efficient, not only in regard to time but also as a quick and concise way to share information with his GP without much preamble. Although the GP initiates the consultation by asking Simon how he is doing, a joint movement towards efficiency is observed. Thus, according to Simon, video consultations include minimal social talk. The patient and GP quickly move to the core of the issue during video consultations.

Seen through an ANT lens, we argue that the length of the video consultation is tied to values that are mediated between the hybrid actors in the network. Thus, time efficiency as a value of video consultation is not necessarily a planned or intentional value but lies implicit in the network involved in the practices of video consultation (no waiting; less social talk; getting straight to the point). From this perspective, values of time efficiency and a general wish to be effective impact how video consultation is enacted and practiced by the actors in the network: the practice staff or GP, the patient and technology. It can be argued that none of the human actors involved in the network are actively working to shorten the consultation time in the video consultation, rather it is a consequence of how the non-human (the technology) and the human actors interact with each other. In other words: video consultation affords emerging efficiency.

Emerging control

Emerging control as a gained benefit

According to the participants, the new opportunity to book video consultations has lessened the impact of impractical aspects of traditional scheduling systems and general practice opening hours. As some participants made clear, part of the reasoning for using video consultations to consult the practice staff or GP stemmed from an experienced discordance between their work schedules and the inflexible consultation structure of general practice, with opening hours typically from 08:00 until 15:00/16:00 and few time slots available due to a pressured general practice setting.

For example, Laura works part-time and has a problem taking time off work for a face-to-face consultation with her GP. Using video consultation, she can consult her GP from her workplace during a break.

From an ANT perspective, the traditional consultation structure of general practice is a black box that has been stabilised and experienced by patients as non-negotiable and invisible, making it necessary for patients to fit their schedules around general practice. However, with the introduction of video consultation, the black box becomes visible and patients can work around the consequences of the non-flexible scheduling system by drawing on the abilities that video consultation affords (e.g., consulting a GP directly from the workplace). For a patient like Laura, this reduces the workflow disruption that consulting her GP physically would otherwise imply.

As such, video consultations provide participants with an increased feeling of flexibility and of being in control in relation to planning their time. As Olivia explains:

… [B]ecause, I quite often find that there is a really long waiting time at my doctor's. Even if I just need to receive a test result. I can wait three weeks, because it is not possible to get appointments (…) I might get a little angry. I don't want to have to plan three weeks in advance (…) then I'd rather have the flexibility so that I know, okay, it might actually be that I'm away (…) visiting some friends, but still have the possibility of keeping this appointment. Even though I am somewhere else in the country. So, in any case, it was the reason why I chose that this time it should be a video consultation. (Olivia)

For Olivia, choosing a video consultation increases her personal freedom. She is not tethered to a specific location but is free to travel or utilise her time as she wishes. With the use of video consultations, Olivia gains control over her own time without impacting her doctor's time. As the excerpt above illustrates, the black box of general practice consultation structure is circumvented by introducing video technology, allowing for re-negotiation of previous requirements (like physical presence and the need to plan ahead) and affording emerging control.

The emerging need for pre-existing control

Throughout the participants’ accounts, another dimension of control emerged as part of why they chose to book a video consultation. Whereas control in the sense of time management was afforded by the video technology, there is also an element that relates to the patient's health problems and perceived feelings of control. Thus, if the patients feel that their health problems are stable, and they experience a high degree of certainty and a low level of concern regarding the outcome of the consultation, then these factors would enable them to book a video consultation. While this kind of control does not directly act as a motivation for video consultation, it becomes a sizeable part of the decision-making process behind booking a video consultation. In these situations, the video technology as an actor in the network sets demands for control that need to be met by the potential user (in this case, the patient), before a successful hybrid actor (video-patient) can be enacted. This kind of control is also exemplified by Laura, who received a diabetes diagnosis around the time video consultations were introduced in general practice (during the Covid-19 pandemic). She continued with the use of video consultations in post-pandemic times, predominantly to receive results from her blood sugar tests. She explains:

[…]if there is something wrong, I think you would be automatically called in… I don't think they will just sit there and say “no, it's much too high”, I think you have to go up there if that's the case that it is dangerous… but if it was dangerously high, I don't think they would say it. I do not think [practice staff] would say that over video. He would say you should just come up [to the clinic]. (Laura)

As the excerpt illustrates, Laura feels assured that the healthcare professionals managing the video consultations are in overall control, meaning that if something serious is at stake regarding her health, the healthcare professionals would call her in for a face-to-face consultation.

Thus, while efficiency with and control over time are key factors for Laura, they hinge on the amount of control she feels that she and the healthcare professionals have over her health. Laura books video consultations unhindered, as she feels in control of and has certainty about her illness. Here we see signs of how the hybrid actor of video-patient is also dependent on other actors within the network, as having certainty and control over illness allows for the use of video.

In conclusion, control as a value tied to video consultation, motivating its use, is both afforded through video technology (via remoteness) and dependent on control (as in certainty) regarding the patients’ health situations.

Emerging diminished presence

Most participants could give examples of how their own or others’ illness situations would be too complex or sensitive for video consultations, often referring to the diminished presence tied to video-mediated interaction which could make patients feel more vulnerable. These ideas of vulnerable situations often overlapped with the elements presented above around emerging control, as patients did not wish to have diminished presence and a lack of control simultaneously when using video consultation. In other situations, however, diminished presence emerged as a value within the network, meaning that in some situations the diminished presence of a video consultation was in fact perceived as a benefit. These were characterised as situations in which patients opted for diminished presence in the encounter with their GP due to a need to hold their emotions at bay. Olivia, for example, was affected by anxiety during Covid-19 and reflected on the level of presence she needed when consulting her GP about it. She explains:

I actually think that I once had… a really troubled time during Covid-19, with anxiety and such. And I thought that it was a bit like, “should I do this on video, or should I not do this on video.” Because somehow, it is nice enough with this distance, rather than if you meet physically. Because there (in the clinic) I also feel that you easily tend to experience a breakdown (emotionally)… The thing where you feel that they actually see and hear what you are saying and try to say. Then it may well happen that you start to break down. Because there is finally someone who actually listens to what you have to say. So that is it… Yes, and maybe I'm not that good at it… being listened to. It might be a bit (hard emotionally). (Olivia)

In this excerpt, video, and how video is perceived to affect presence, are taken into account when Olivia reflects on how she consults her GP about her anxiety. She opts for the video consultation precisely because diminished presence emerges in the encounter, as opposed to an encounter based on physical proximity. Consulting her GP through a video consultation provides Olivia with the ability to take control of her own feelings through the diminished presence that emerges in this medium. Diminished presence does not open up Olivia's emotional vulnerability, and it keeps her in control of her feelings as she explains her health situation. She is not confronted physically with the GP's reaction from listening to her mental challenges.

Diminished presence is closely tied to the use of and the agency of video technology. As a value, it first emerges within the network that already values and cultivates these effects. This point can be inferred from how some of the study participants talked about being motivated to book a video consultation because they were seeking quick and convenient solutions to their health problems. This is interpreted as the participant's choice for efficiency and control, despite the limitations that diminished presence brings, thereby tying the values closely together.

The participants in this study perceived themselves as having a high degree of autonomy and a great self-perceived understanding of their situations. Consequently, they needed less presence than “others,” referring to those patients for whom presence was seen to be a requirement and video consultation seen as a less appropriate choice. The reference to “others” included people who were lonely, elderly, or mentally vulnerable. By describing groups of “others,” it became clear that the participants did not see themselves as belonging to these categories despite their age or mental health and well-being status.

The identification of “others” who, according to the participants, should not take part in the mediating effect of video consultations (in this case, diminished presence), illustrates that participants were aware of the effects of interacting through video. It also illustrates, we argue, that diminished presence emerges as an effect co-created by the situated needs, preferences and valorisations of the hybrid actor of video-patient in the video consultation network.

Discussion

Our findings suggest that video consultations mediate consultations in ways that affect efficiency, control and diminished presence, all of which users find acceptable, negotiable and manageable and that are perceived as values motivating them to book video consultations. Thus, the study participants represent a group of users who have easily adapted to the values emerging through the use of video consultation. Furthermore, the findings indicate that video is a time-efficient experience that grants freedom of geography and circumvents current consultation structures perceived as constraining by patients. Video consultations are closely connected to control, as we have shown, both increased control over one’s own time and a level of control over one's health. As part of the mediation of patients, the concept of video-patient hybrid has been introduced, pointing to how the connection between video consultation technology and patients mitigates feelings of diminished presence, which experienced users are aware of and navigate when booking.

This is not the first article to note that video changes and mediates the consultation.^30–33 What we have added to the current knowledge pool is an in-depth understanding of how values and intentions tied to video consultations emerge through technical mediation and act as motivations behind choosing to book a video consultation.

Shaw et al. ³⁰ describe video mediation in terms of technical disruptions to conversational flow that should be overcome and navigated. ³⁰ With differences in understanding of mediation, our findings suggest that there is more at stake than this, and we have shown the mediation processes that the experienced patients knowingly participate in and use according to their needs. Video mediation is more than technical disruptions, latency in responses and navigating turn-taking. We show how patients knowingly engage with emerging values of efficiency, control and diminished presence and perceived drawbacks in video consultations.

The technology-mediated inter-social presence previously described as “telepresence” by Jeannette Pols ³² is practised by patients, practice staff, or GPs. This theoretical concept acknowledges that presence changes in technology-mediated encounters, such as video consultations, “turning geographic distance into relational distance.” ³² We have pointed out how, when it comes to understanding reasons for booking video consultations, the meaning of social presence is more complicated. As we have shown, the emergence of diminished presence is not only an increase in relational distance, but also a beneficial consequence of mediation, that allows for efficiency and emotional distance between patients and GPs, and also between patients and their health issues. Research on psychological services delivered through video consultation has pointed out similar patterns, as video can impact feelings of presence in both positive and negative ways. ³⁴ It has been shown that psychiatric patients may sometimes experience more control if they are allowed to act as less present through video, especially if they also have control over the camera. Conversely, the treating physicians do not share these experiences of higher satisfaction, as it poses a challenge for them to have to decide who might benefit from this distance. ³⁴

Our analysis illustrates how technology can circumvent the black box practices (e.g., general practice workflow and appointment structure). By circumventing this black box, patients can gain control over time and efficiency. Most of the negotiations mentioned throughout the article are not overtly visible but descriptive of smaller negotiations and interactions between patients, the GP, or practice staff. The relationships among the various emerging values mentioned above are closely interconnected and should be viewed as a collective parameter.

The literature on video consultation also contains some preconceptions regarding video consultations as the obvious choices for greater geographic distances and rural areas.^32,35,36 This article shows the relevance of video consultations in an urban area with shorter geographic distances. It thereby challenges the current narrative that video consultations are for avoiding long distances and shifts the focus from distance to time, as video consultations help save different kinds of time.

From a patient's perspective video consultations are negotiable and acceptable, with the small caveat that medical and emotional responsibility is partly transferred to the GP and practice staff. This comes at a time when responsibility and authority in the patient-GP relationship are already evolving and undergoing change. ²⁷ A similar pattern of patients expecting GP responsibility can be seen in the exploration of AI implementation. ³⁷ A general tendency is taking form: patients trust their GPs to be responsible for new technology in general practice.

In this instance, the transfer of responsibility to assess what is valid to conduct through video does not align well with current procedures, as general practice clinics do not have established systematic approaches to determine ahead of time when something is medically or emotionally unfit for a video consultation. Such procedures seem counterproductive to current digitalisation aims and are also labour intensive, as they demand a great understanding of every patient because vulnerable topics are subjective and individualistic. Further experience with video consultations, particularly among patients, would generally improve the ability to assess when video consultations are suitable.

Strengths and limitations

This study's interview guide was not validated or pilot-tested before use. However, using a semi-structured approach where the wording could be changed during the interview to better accommodate the study participants and give them space to give examples of their own experiences and reasonings for using video consultations, allowed the guide to be adapted to fit the interviewees.

The multidisciplinary training of the research team behind this article is a strength, as methodological, theoretical and thematic knowledge allowed for in-depth knowledge development.

All study participants were recruited from the same general practice clinic located within a larger Danish urban area, which used video consultations more than the national average and allowed for online booking, which was outside the norm at the time of recruitment. This approach to recruitment and purposive sampling strategy, focusing on online booking with minimised influence by health professionals, has secured study participants with ample experience of video consultations but who are not representative of the general Danish population. To clarify, the patient chose video without interference at the time of recruitment. Still, the clinic from where the participants were recruited has nudged patients towards the use of video consultations since the technology was introduced.

This approach strengthens our argument for mediation among the specifically selected group of experienced users. However, it should be kept in mind that in Danish general practice video is currently used in less than 2% of contacts between patients and GPs, which makes it an uncommon experience among patients. While the high use of video consultation among our participants can be seen as a limitation, as the results are perhaps not easily generalisable, the study findings are transferable to contexts similar to those in our study. Also, our results can be expected to gain more relevance if the political aim of digitalisation is met and all Danish GPs make video consultations available to patients by the end of 2024.^6,8

Conclusion

Patients who choose to book video consultations within a Danish general practice context do so because they are efficient and solution-oriented. Patient-initiated bookings of video consultations are motivated by a wish for an effective consultation, which is possible when patients experience little to no uncertainty regarding their health issues. Video consultations enable the patient to be in control, and patients trust their GP to intervene and change the consultation form if something changes, is too emotional or would make the patient vulnerable if they received the information through a video consultation.

Video consultations and the focus on being efficient mediate the relational distance between patients and GPs or practice staff, which patients are aware of and consider when they book the video consultation and use actively when presence is not desirable.