"A disembodied voice over the telephone”: A qualitative study of healthcare practitioners’ experiences in geriatric medicine.

Objectives: This study explored the experience of delivering care remotely among practitioners in a UK geriatric medicine clinic. Methods: Nine semi-structured interviews were conducted with consultants (n=5), nurses (n=2), a speech and language and an occupational therapist, and thematically analysed. Results: Four themes developed; Challenges of remote consultations; Perceived advantages of remote consultations; Disruption of involvement of family members; Impact on care staff. Participants felt that rapport and trust had been more feasible to develop remotely than they had anticipated, although this was more challenging for new patients and those with cognitive or sensory impairments. While practitioners identified advantages of remote consultations, including involving relatives, saving time, and reducing anxiety, they also experienced disadvantages such as consultations feeling like a ‘production line’, missing visual cues and reduced privacy. Some participants felt their professional identity was threatened by the lack of face-to-face contact, linked to feeling that remote consultations are not suitable for frail older adults or those with cognitive deficits. Discussion: Staff perceived barriers to remote consultations that went beyond practical concerns, and suggest support for building rapport, involving families, and protecting clinician identity and job satisfaction may be warranted.