**1. Introduction**

The emerging use of mobile medical consultation in China has propelled the establishment of doctor-patient relationships (DPRs) in the mobile context. DPR relies on mutual familiarity, trust, and interaction between physicians and patients during healthcare planning [1], and is essential for developing superior healthcare services. Given its significance, ample attention has been paid to exploring the antecedents and outcomes of DPR [1–4]. With the wide application of mobile medical consultation in China, people are allowed to interact with doctors to make inquiries and obtain medical information through computer-mediated communication [4,5]. Through this service, the scenes where DPR is established are extended from the offline context to the mobile context. In addition, mobile medical consultation service offers medical information not only for patients but also for other users who are not necessarily patients. To avoid confusion, we use the term "user(s)" when discussing DPR in a mobile context.

Compared to the rapid increase of mobile medical consultation users, perceptions towards mobile DPR is less optimistic. According to a related industry report, more than 40% of doctors have reported that they consider the DPR to be tense in a mobile context [6]. Hao and Zhang [7] found that 12% of users made negative comments on the treatment effect, and 9% made negative comments on the service attitude of doctors on a Chinese mobile consultation platform. Poor DPR not only impairs users' health conditions at the individual level [8] but also causes serious social problems at the society level [9].

Extant research on mobile healthcare service is emerging, but studies that aim at uncovering the underlying reasons for poor DPRs in the mobile context are still lacking. The majority of previous research tends to focus on the positive experience brought about by mobile healthcare services, such as user satisfaction [10] and the adoption or continuous usage of mobile technology [3,11]. However, the experience of dissatisfied participants is largely ignored. The negative experience is also worth noting because understanding the complaints guide practitioners to improve service quality [8]. Although a few studies have paid attention to the dissatisfying experience of mobile healthcare services, they tend to interpret the experience only from the perspective of users [8,12]. While these studies are insightful, a single perspective from users is not adequate, because they missed the perception of doctors which is considered quite di fferent from that of users [13,14].

These two literature gaps (namely lacking studies on dissatisfying experience of mobile healthcare services and lacking dual perspectives from both users and doctors) might partly be attributed to the mainstream research method in the healthcare field. Most studies rely on questionnaires and interviews to collect subjective ratings about mobile healthcare services, such as Akter et al. (2013) [15], Deng et al. (2015) [16], and Wu et al. (2018) [17]. The collected responses are usually inaccurate since respondents are rating events that happened at an earlier time. Besides, it is di fficult to match responses from doctors and patients via questionnaires.

This work aims to uncover the underlying reasons for poor DPR from dual perspectives of both doctors and users in mobile medical consultation service. To achieve our goals, we first reviewed the literature on Computer-Mediated Communication (hereafter, CMC) in search of theoretical accounts for the poor DPR in the mobile context. The CMC literature focuses on the influence of the features of CMC on communication processes, which enables us to understand the potential negative impacts that CMC brings to doctor-user communication. As a result, the CMC literature guides us to identify the underlying reasons and mechanisms of poor DPR in the mobile context [18].

Next, we conducted an in-depth qualitative analysis based on objective communication records collected from a leading Chinese mobile healthcare application, Chunyu Doctor, to validate and refine the theoretical accounts. Chunyu Doctor is a commercial mobile consultation platform that connects users who search for medical information and doctors who work in public hospitals in China. On this platform, doctors are free to define their service prices and can earn legal income by providing consultation services for users. Meanwhile, users can pay a fee to consult doctors and make service evaluations after the consultation. Users can consult doctors either by telephone or by texts and pictures, but the latter is more frequently adopted in practice. This mobile platform is chosen due to the following two reasons. First, founded in 2011, Chunyu Doctor was among the first to start a mobile consultation service in China. By the end of 2017, it had accumulated 125 million users and 500 thousand physicians and conducted more than 330 thousand consultations per day, which allows us to ge<sup>t</sup> access to a large number of real communication records. Second, Chunyu Doctor provides users with a service evaluation system, in which a user can rate the service as "satisfied", "general" or "dissatisfied". Analyzing communication records rated as "dissatisfied" is helpful to discern potential problems in mobile consultation from both users' and doctors' perspectives.

The findings of this work contribute to the theorizing and understanding of DPR in the mobile context by o ffering theoretical accounts from the perspective of CMC. We also shed light on e ffective ways to improve users' or doctors' satisfaction towards mobile healthcare service. Both users and doctors are suggested to change their expectations and interaction habits to better adapt to the features of mobile communication.
