Patient and practitioner relationship

Patient practitioner relationship

The interaction and communication between a healthcare professional and a patient

Practitioner interpersonal skills

Communication and social skills used by healthcare professionals when interacting with patients

Non verbal communication

Communication through appearance, gestures, facial expressions and body language

McKinstry and Wang (1990) aim

Investigate the role of a doctor's appearance as a form of non verbal communication

McKinstry and Wang (1990) sample

475 patients seeing 30 doctors across five general medical centres in Scotland

McKinstry and Wang (1990) procedure

Participants were interviewed about their opinions of eight photographs

McKinstry and Wang (1990) photographs

Five male doctors and three female doctors wearing different attire

McKinstry and Wang (1990) questions

Participants rated which doctor they preferred, trusted, disliked and thought resembled their own doctor

McKinstry and Wang (1990) rating scale

Participants rated their preferred doctor from zero to five

McKinstry and Wang (1990) sampling procedure

Patients were sampled at different times on five occasions at each surgery

McKinstry and Wang (1990) sampling coverage

Interviewers saw an average of over 70% of available patients

McKinstry and Wang (1990) male doctor preference

Patients significantly preferred male doctors wearing formal suits and ties

McKinstry and Wang (1990) female doctor preference

Patients preferred female doctors wearing white lab coats

McKinstry and Wang (1990) age and social class finding

Older and higher class patients preferred traditionally dressed doctors

McKinstry and Wang (1990) informal clothing finding

28% would be unhappy seeing informally dressed doctors

McKinstry and Wang (1990) clothing importance

64% considered their doctor's clothing quite or very important

McKinstry and Wang (1990) gender finding

Female doctors received higher ratings than male doctors

McKinstry and Wang (1990) confidence finding

41% were confident in the ability of the formally dressed doctor

McKinstry and Wang (1990) limitation

A female doctor wearing a formal suit was not included in the photographs

McKinstry and Wang (1990) evaluation strength

A wide sample from different doctors and clinics increases representativeness

McKinstry and Wang (1990) evaluation demand characteristics

Some patients said clothing was not important, suggesting responses were not entirely influenced by demand characteristics

McKinstry and Wang (1990) evaluation gender limitation

Women may face greater pressure to conform to clothing stereotypes

McKinstry and Wang (1990) individual and situational debate

Patients have individual preferences, while social expectations influence clothing preferences

Verbal communication

Communication using spoken or written language

McKinlay (1975) aim

Investigate patients' understanding of medical terminology used by doctors

McKinlay (1975) pilot study

Identified words used by doctors in a Scottish maternity hospital

McKinlay (1975) word classification

Words were classified as commonly understood, incomprehensible or between these categories

McKinlay (1975) words tested

57 medical words were examined

McKinlay (1975) middle category

13 words were classified as falling between commonly understood and incomprehensible

McKinlay (1975) focus

The 13 words in the middle category were used to investigate patient understanding

McKinlay (1975) interview procedure

Participants read and heard each word used in a sentence before defining it

McKinlay (1975) scoring procedure

Two independent doctors scored patients' verbatim responses

McKinlay (1975) blind scoring

The doctors did not know the participants or each other's scores

McKinlay (1975) doctor expectations

One year later, doctors rated how well a typical patient would understand each word

McKinlay (1975) doctor rating scale

A meant no understanding and D meant understanding pretty well

McKinlay (1975) inter rater reliability

The two doctors gave the same or similar ratings

McKinlay (1975) underuse finding

Patients who underused medical services understood fewer medical words than regular users

McKinlay (1975) regular user finding

Regular users had poorer understanding of the words navel and rhesus

McKinlay (1975) pregnancy finding

Women with at least one child understood slightly more words than women attending during their first pregnancy

McKinlay (1975) purgative finding

Both groups had lower comprehension scores for the word purgative

McKinlay (1975) rhesus finding

Some women associated rhesus with blood group but this was not considered adequate understanding

Ley (1988) focus

Investigated how frequently patients forget verbal advice given by doctors

Ley (1988) forgetting factors

Amount, order, perceived importance and nature of information affect forgetting

Ley (1988) additional forgetting factors

Age, anxiety and medical knowledge also affect forgetting

Ley (1988) communication recommendation

Practitioners should use simple language

Ley (1988) information order recommendation

Essential information should be stated first

Ley (1988) repetition recommendation

Practitioners should advise and repeat important points

McKinlay (1975) evaluation strength

Blind scoring and clear interviews increased the validity of the data

McKinlay (1975) evaluation reliability

Standardised procedures increased reliability

McKinlay (1975) evaluation ethical strength

Only doctors were tested, reducing the risk of psychological harm to participants

Ley (1988) application

Practitioners can improve communication by using simple language and repeating key information

Doctor beliefs and patient behaviour

Doctors' beliefs about patient understanding can influence how they communicate

McKinlay (1975) everyday application

Doctors should use understandable terminology because patients may not understand medical terms

McKinlay (1975) individual and situational debate

Patient knowledge differs individually, while doctors' expectations are situational factors

Practitioner style

The way a doctor communicates and interacts with patients during consultations

Doctor centred consultation

A consultation in which the doctor takes control of the interaction

Patient centred consultation

A consultation in which the patient has a more active role in the interaction

Byrne and Long (1976) aim

Investigate interactions between patients and practitioners

Byrne and Long (1976) sample of consultations

Approximately 2500 medical consultations recorded in several countries

Byrne and Long (1976) procedure

Consultations were tape recorded and analysed

Byrne and Long (1976) practitioner style finding

Doctors tended to use a consistent consultation style with different patients

Byrne and Long (1976) consultation styles

Most consultations were classified as doctor centred or patient centred

Byrne and Long (1976) reflection finding

Few doctors could reflect on the dynamics and process of consultations

Six phases of consultation

Establishing a relationship, discovering the reason for attendance, examining the patient, considering the condition, discussing treatment and ending the consultation

First consultation phase

The doctor establishes a relationship with the patient

Second consultation phase

The doctor discovers the reason for the patient's attendance

Third consultation phase

The doctor conducts a verbal or physical examination

Fourth consultation phase

The doctor and patient consider the condition

Fifth consultation phase

The doctor and sometimes the patient discuss further treatment

Sixth consultation phase

The doctor ends the consultation

Doctor centred questioning

Uses closed questions requiring short answers such as yes or no

Doctor centred consultation focus

Concentrates on the first problem mentioned by the patient

Doctor centred consultation limitation

May ignore other problems experienced by the patient

Patient centred questioning

Uses open ended questions that allow patients to describe their experiences

Patient centred consultation advantage

Allows patients to provide more information and introduce relevant facts

Patient centred consultation communication

Avoids medical jargon and allows patient participation in decision making

Savage and Armstrong (1990) aim

Compare the effects of directing and sharing consultation styles on patient satisfaction

Savage and Armstrong (1990) design

Random allocation to consultation conditions

Savage and Armstrong (1990) sample

359 participants aged 16 to 75 presenting with symptoms

Savage and Armstrong (1990) consent

Patients were asked for permission to record their consultations

Savage and Armstrong (1990) satisfaction measures

Two questionnaires assessed communication quality and patient thoughts

Savage and Armstrong (1990) questionnaire timing

Questionnaires were completed immediately and one week after the consultation

Savage and Armstrong (1990) results

Both consultation styles received high satisfaction ratings

Savage and Armstrong (1990) directing style finding

Patients reported greater satisfaction with their doctor's explanation

Savage and Armstrong (1990) conclusion

Authoritarianism and certainty may be important in satisfying patients

Directing consultation style

The doctor takes control and gives clear instructions and explanations

Sharing consultation style

The doctor involves the patient more actively in decisions

Byrne and Long (1976) evaluation limitation

Tape recordings captured verbal communication but not non verbal cues such as gestures

Byrne and Long (1976) generalisability

Consultations from several countries may allow findings to generalise across populations

Byrne and Long (1976) qualitative data limitation

Large amounts of recorded data can be subjective and reduce reliability

Savage and Armstrong (1990) evaluation design

Used an independent measures design with participants in one of two conditions

Savage and Armstrong (1990) evaluation limitation

Individual preferences for consultation styles may act as confounding variables

Consultation styles everyday application

Doctors should consider their communication style when interacting with patients

Consultation styles individual and situational debate

Patients may have individual preferences influenced by situational factors

Consultation styles cultural bias

Both studies were conducted in Western countries, so findings may not apply to all cultures

Cultural preferences in consultations

Some cultures may prefer a direct approach from doctors

Type I diagnostic error

Diagnosing a healthy person as ill

Type II diagnostic error

Diagnosing an ill person as healthy

Diagnostic errors

Incorrect diagnoses that may occur during screening, consultation or treatment

Screening

Relatively cheap tests given to large populations to identify possible disease