McKinlay 1975 - Verbal communication

aim

to investigate the understanding of technical language among working class families in a Scottish maternity ward

sample

- 87 unskilled, working class families

- families were accessing obstetrics, gynaecology appointments

controls

- participants were split into 2 groups:

a) utilisers

b) underutilises

- blind scoring was used where patients were assigned a number so practitioners who were scoring the responses did not know whether they were utilisers or underutilises

apparatus

- structured interview

- practitioners working on that particular war developed a list of 13 words normally used with their patients

- participants responses were recorded verbatim

- 2 practitioners who work on the wards placed participant responses into categories:

--> not understood the word at all and said they had not

--> gave a response but the meaning was completely wrong

--> gave an incomplete or unclear response

--> had a good understanding

Method

- Patients heard the word spoken aloud.

- Then heard the word in context in a sentence.

- Patients were then asked to say the meaning of the word.

- McKinlay investigated the relationship between how well practitioners thought that patients would understand the medical terminology, and how many of the patients actually used the words.

Results

- Higher word comprehension amount utilisers on a number of words

- Some words showed a lack of comprehension from both groups

- Doctors showed a consistent underestimation of their patients knowledge for both utilisers and underutilises

Conclusion

- Doctors underestimated the level of comprehension of their working class participants

- A large % of doctors used certain words when communicating, despite the fact that they thought the patients would have little understanding of them

- Therefore the responsibility for the lack of understanding actually lies with the practitioners for

a) Using medical terminology when they assume patients wont understand them

b) For underestimating the abilities of their patients to understand the terminology

What was the theory for this study

Clarity of message - often patients lack important knowledge about their treatment.

Doctors and serious messages - it has been recommended that when breaking difficult news doctors should: use simple non-technical language, use open-ended questions, and empathetic statements.

FACTORS AFFECTING VERBAL COMMUNICATION:

Primary effect - where info from the beginning of the consultation is most likely to be remembered better than the other info from the discussion, as the info will be stored in the patients long term memory.

Forgetting - patients often remember little of their appointments and research has been shown sometimes as little as 20% of the info and 40-80% of what was said to them at their appointments.

A lack of understanding - this had previously been blamed on the patient, but now attention has turned to the way practitioners communicate with their patients and the medical terminology used.

Strength of the study

One strength is that the study had high ecological validity. For example, patients were interviewed at the clinic about words that they would be likely to hear in one of their clinic sessions. Therefore, their understanding of the words presented is likely to represent their real-life understanding of the language used in their clinics.

Weakness of the study

Another weakness is that the sample were all working class mothers attending obstetric or gynaecologist appointments and are therefore unrepresentative of the target population. There may be something about this sample in terms of the type of appointments they are attending or their social class which makes the results more likely. If patients with a wider range of conditions, from more diverse social classes were included, then the results may be different; suggesting the findings might not be generalisable.

I&D - application to everyday life

One strength of the study is that it is applicable to real-life situations. This means that the focus is moved away from the patient and towards the practitioner. Practitioners can take responsibility for communication barriers, and strategies can be developed to improve comprehension. For example, in some hospitals new mothers look at new literature that is designed for parents who are expecting a baby to see whether the terminology used is likely to be accessible and understandable by patients from different backgrounds. This shows how the results of the study have helped to change working practices in health care.

I&D - idiographic vs nomothetic

One possible weakness is that researchers looking at practitioner and patient interpersonal skills use a nomothetic approach and focus on groups of people. Although this can be useful in terms of generalising their findings, it can be argued that an idiographic approach would be better as qualitative methods can be used in order to discover individual needs the patients may have. It might be that those needs change depending on their circumstances. For example, a patient visiting the doctor with back problems might need a different style of communication than if they have mental health problems or receive a diagnosis of a potentially life changing illness such as cancer.