Uncovering Respect in the Clinical Encounterusing a respectful, qualitative methodology: Video Reflexive Ethnography

Abstract

Background and purpose: To truly enrich healthcare debates and improve the quality of care in clinical encounters, we must become more aware of and sensitive to the views of participants in the encounters. This is often done through surveys of physicians, qualitative interviews or focus groups. Video Reflexive Ethnography (VRE) provides an alternative approach to capture a deeper understanding of what matters to clinicians and patients in the clinical encounter. We argue that VRE is particularly well-suited to research on the clinician patient relationship in clinical encounters as it is a methodology that is itself relationship driven, respectful of participants, and grounded in the clinical encounter. We employed VRE to understand patients and clinicians’ perceptions of what constitutes respect and here we focus on the methodological insights of VRE as a respectful methodology that emerged in this work.

Methods:

VRE, a collaborative qualitative methodology was used in three phases to study respect in the clinical encounter, (1) video ethnography to observe the clinical setting and video record 8 clinical encounters in the primary care clinic of a large academic hospital in Minnesota, USA (2) video reflexivity to video-record 15 one-hour video-reflexive sessions with 7 clinicians and 8 patients and (3) to share results with the practice for quality improvement. Video-graphic data was transcribed and analyzed according to grounded theory.

Findings: Five themes emerged from an analysis of VRE as a respectful methodology. (1) Methodological considerations (2) Relationship Building: involving clinical champions, providing explanations of the methodology, generating trust through reassurance (3) Researcher presence: style of video-recording, collaboration with participants and researcher reflexivity (4) logistics: using more than one camera, positioning of video-recorders, size of the room and screen and influence of sound in reflexivity sessions and (5) New ways of seeing: regarding oneself on camera and reflecting participant’s views all demonstrate how VRE is a respectful methodology that is particularly well suited to collaborating with patients and clinicians in a research context.

Discussion: The origin of the word respect means to look again and VRE uses video to invite participants to see themselves and their encounters in new ways. Employing VRE for the first time in a primary care setting at a Midwestern health system generated insights showing how respect is intrinsic to the successful application of VRE. These insights are shared so that researchers using VRE may continue to do so in new contexts and settings respectfully.