Constraints and Workarounds to Support Clinical Consultations in Synchronous Text-based Platforms

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Medical consultations over synchronous text-based platforms are becoming increasingly popular for virtual care, yet little is known about how physicians translate their training to this healthcare medium. We report the constraints, workarounds, and opportunities highlighted by eight primary care physicians who used such a platform in simulated medical scenarios with standardized patients. We found that due to the perceived inefficiency of communicating over text, the physicians made subconscious use of double-barreled questions and action multiplexing to streamline the conversation. In addition, the physicians overcame the lack of missing verbal and visual cues by adding explicit messages to convey empathy and active listening. We also identify several affordances of text-based platforms, such as the ability for users to reference the conversation history and for patients to feel a sense of privacy during sensitive disclosure. From these findings, we propose design opportunities for how future synchronous text-based platforms can better support medical consultations.