Patient-centred interviewing in Outpatient Departments: A doctor-client perspective

Abstract

Background: The medical interview is the most common undertaking by a physician. On average, a doctor performs over 200,000 interviews during his career. The traditional medical interview was centred on the clinician. In the late 1970s, the bio-psychosocial model was first introduced by Engel and followed by McWhinneys’ as patient-centred approaches which were swiftly adopted into practice by clinicians. However, in Sri Lanka, no clear evidence could be found to suggest that patient-centredness in the medical interview was given much emphasis in the past. Research evidence available from the local setting on this field is limited. Against this backdrop, it is imperative to assess the perceptions of patient-centred interviewing among the doctors as well as patients.Objective: To assess the doctor and patient perceptions on patient-centred interviewing in Outpatient Departments (OPD) consultations.Methods: A descriptive cross-sectional study was conducted in OPDs of government hospitals in the Colombo Regional Director of Health Services division. All doctors and a sample of patients over the age of 18 years were included. Data collection was done through a self-administered questionnaire and focus group discussions. Data analysis was done by using MS Excel and framework thematic analysis.Results: Both doctors and patients perceived the short consultation time as a leading challenge to have patient-centred interviews in OPDs. In addition, interviewers being disrespectful to patients, providing inadequate information, not getting the involvement of the patient in decision making, and having poor listening skills were negatively perceived by the patients. Overcrowding, heavy workload, stressful work conditions, lack of privacy, and low priority given by the hospital management to OPD functions were perceived by the doctors as barriers to improve the patient-centred interviews. Even though the majority of the doctors have already undergone communication skills training, their willingness to learn and improve these skills was noted.Conclusions and Recommendations: As perceived by the partakers, the patient-centred interviewing in the OPDs has multiple challenges. Placing more emphasis on organizing communication skills training, ensuring longer consultations, providing a more responsive working environment for the doctors, ensuring privacy and confidentiality of transpired information, reformulating OPD functions are recommended.