Importance of Communication in Diagnosis

• Type of information disclosed by patients is vital for diagnosis.

• Patients may perceive inadequacies in communication due to:

  • Content Skills: Substance of communication (questions, information, differential diagnosis).

  • Process Skills: How information is communicated (listening, structure, relationship building).

Non-Verbal Communication

Study: McKinstry and Wang (1991)

• Aim: To investigate how patients perceive different styles of doctors' dress and its influence on respect for their opinions.

• Method: Showed pictures of the same male and female doctor in formal and informal dress to 475 patients across 5 surgeries. Patients rated their comfort and confidence in seeing the doctor.

• Results:

  • Higher acceptability for traditional dress (white coat & suit for males; white coat & skirt for females).

  • Lower acceptability for casual dress (jeans, earrings, etc.).

  • Expectations regarding doctors’ attire: 15% expect a white coat, 44% a suit, 67% a tie.

• Conclusion: Traditional dress enhances patient confidence, particularly among older and professional-class patients.

• Strengths: Shows importance of appearance and first impressions.

• Weaknesses:

  • Reductionist: Non-Verbal Communication (NVC) is more complex than attire.

  • Lacks ecological validity: used images, not real interactions.

  • Cultural bias due to being conducted in the UK.

Verbal Communication

Study: McKinlay (1975)

• Aim: To assess comprehension of medical terms among lower-class women in a maternity ward.

• Findings:

  • On average, <40% understood medical terms like "antibiotic" and "suture."

  • Health workers underestimated patients’ understanding but used complex terms.

• Implications: Need for clearer communication in healthcare to improve understanding.

• Strengths: Ecologically valid as terms were real and relevant.

• Weaknesses: Limited generalizability since only women in a maternity setting were studied.

Study: Ley (1988)

• Aim: To evaluate what patients retain from consultations.

• Method: Patient recall was assessed post-consultation.

• Results:

  • Patients remembered about 55% of instructions.

  • Good recall of initial information (Primacy effect); repeated information did not enhance recall.

  • Organizational strategies (signposting, categorization) improved recall.

• Practices Implemented: Doctors encouraged to review information multiple times with patients to enhance memory retention.

Errors in Diagnosis

Types of Errors

• Type I error (false positive): Incorrectly declaring someone ill.

• Type II error (false negative): Failing to identify illness when it exists.

Screening Errors

• Probability thresholds (p-values):

  • p = 0.05: acceptable for non-critical research.

  • p = 0.1: increased risk of Type I errors.

  • p = 0.01: increased risk of Type II errors.

Study: Robinson and West (1992)

• Aim: To compare whether patients would disclose STD-related information more readily via computer or face-to-face.

• Findings: Patients revealed more details (e.g., number of sexual partners) when using a computer, facing less judgment.

General Evaluations

• Individual vs. Situational