Telemedicine in Russian Megacities: Problems and Prospects

The article presents the results of a mixed empirical study carried out in 2020– 2021, which included semi-structured interviews with residents of large Russian cities (N = 90) and a telephone survey of residents of Saint Petersburg (N = 861). The focus of our attention is people’s experience of receiving remote medical consultations, the factors influencing it, as well as the attitudes that have developed towards this sort of assistance. The article aims at identifying possibilities and limitations of a new type of communication between doctor and patient, mediated by digital technologies. Based on the results of the research, conclusions about the prevalence of remote medical consultations, as well as how they are embedded in the everyday life of citizens and how they actualize important aspects of interaction with medical professionals were formulated. It was revealed that remote medical consultations in general need to be separated from telemedicine as one of its variants. According to the results of the study, 25.2% of respondents have communicated at least once with a doctor remotely. Typically such interaction occurs with “trusted” doctors — those with whom personal, and often repeated contact has proven to be effective, and can be initiated by both the doctor and the patient. The situation is different in the case of telemedicine, attitudes towards which can be explained by how the specifics of interaction in the doctor-patient system are perceived. The inability to provide a physical examination and difficulties in establishing personal contact are among the more significant reasons preventing the use of telemedicine. Since telemedicine involves contact with unknown doctors and is always initiated by the patient, the basis for resorting to it is not interpersonal trust in the specialist, but the presence of institutional trust in the healthcare system and a significant degree of patient autonomy. People who are aware that they have health problems and have a habit of taking care of themselves in various different ways, including by means of monitoring medical recommendations, are more likely to communicate remotely with a doctor. A higher level of income increases the chances of resorting to such consultations. Predictably, representatives of older age groups turned out to be in the outsider group.