Communication In Medical Consultations Research Articles

Interventions for improving medical students' interpersonal communication in medical consultations.

Interventions for improving medical students' interpersonal communication in medical consultations.

Interventions for Improving medical students' interpersonal communication in medical consultations; Considering the evidence in the context of the COVID-19 pandemic

Interventions for Improving medical students' interpersonal communication in medical consultations; Considering the evidence in the context of the COVID-19 pandemic

The professional interpreter’s effect on empathic communication in medical consultations: A qualitative analysis of interaction

ObjectiveTo investigate how empathic communication is expressed in interpreter-mediated consultations (IMCs) and the interpreter's effect on it. MethodsWe coded 20 authentic video-recorded IMCs by using the Empathic Communication Coding System (ECCS). We compared patient-initiated empathic opportunities (EOs) and doctors' responses as expressed by patients and doctors and as rendered by interpreters. ResultsWe identified 44 EOs. In 2 of the 44 EOs there was a close match in the way the EOs were expressed by the patient in the first place and in the way they were rendered by the interpreter. Twenty-four of the 44 EOs that were passed on by the interpreter to the doctor and presented the doctor with an opportunity to respond, came with a shift in meaning and/or intensity. Twenty of the 44 EOs were not passed on by the interpreter to the doctor. ConclusionIn IMCs, EOs are subject to the interpreter's renditions and the doctor's actions during interaction. Practice implicationsDoctors and interpreters require skills to detect patient cues, assess them correctly, render them completely and in an appropriate manner (interpreters) and display communicative behaviours that take into account the intricacies of interpreter-mediated clinical communication and facilitate each other’s communicative goals.

Interventions for improving medical students' interpersonal communication in medical consultations

Interventions for improving medical students' interpersonal communication in medical consultations

If You Could Read My Mind: The Role of Healthcare Providers’ Empathic and Communicative Competencies in Clients’ Satisfaction with Consultations

ABSTRACTThis article investigates the relationship between healthcare providers’ empathic and communicative competencies and clients’ overall satisfaction with consultations. Two aspects of empathy were included: empathic attitude (sensitivity to the clients’ perspective) and empathic skills (ability to estimate clients’ evaluations). Communicative competencies were narrowed down to the clarity of the information provided. In the context of work disability examinations, 90 healthcare providers (44% physicians, 56% vocational experts) participated. For each provider, up to 20 dyads with clients were investigated. Within every dyad, clients rated their experiences and healthcare providers estimated clients’ scores. The results show that both aspects of empathy and clarity of information significantly contribute to clients’ overall satisfaction and as such confirm the importance of empathy and communication in medical consultations. Specifically, healthcare providers’ empathic dispositions, in addition to their overt communicative behavior, appear to contribute to clients’ overall satisfaction. Of the two aspects of empathy, only empathic attitude is significantly related to the clarity of information.

Abstract 17875: Translating 3D Printing into Clinical Practice: Do Patient-Specific Models Aid in Communicating with Parents of Children with Congenital Heart Disease?

Introduction: Communication in medical consultations is recognised as an important factor in optimising patient satisfaction and health outcomes. Patient-specific (PS) plastic models of congenital heart lesions may offer benefits for education and communication purposes. This study aimed to quantitatively test the translational potential of PS models in a systematic manner. Methods: Parents of children with congenital heart defects (n=97), matched for age, sex and level of education, were divided into Group I (n=52) for normal consultations/follow-up visits, and Group II (n=45) where PS models generated from magnetic resonance imaging and printed in white nylon with rapid prototyping machine model were additionally used. Participants and cardiologists completed rating scales (scored from 0-10) to assess parents’ knowledge of their child’s condition before and after the consultation and to provide feedback on any tools used, including the 3D model. Results: Clinicians reported that the models were very useful (8.8±1.1/10), encouraged parent interaction (9.1±1.4/10), and did not lengthen consultation (93% cases), although these lasted 5 minutes longer (p=0.02). Parents rated PS models as very useful (9.5±0.7/10) and more informative than medical images, with 73% explicitly asking to keep their model. Parents in both groups equally felt their understanding improved following their visit, although when their questionnaires were rated blindly by two cardiologists only 5 participants per group were actually found to demonstrate improved understanding. In 40% of cases the cardiologists were not able to gather even the primary diagnosis based on the information provided by parents after their consultation. Conclusions: Patients’ parents and clinicians found PS models to be useful communication tools, although parents’ understanding appears to be mainly related to their prior level of knowledge. Clinicians found PS models useful in explaining congenital heart defects and encouraging parent interaction. Use of such a modality during the first interactions with parents may have benefits for improving parents’ participation in their child’s management.

Patient Question-Asking About Glaucoma and Glaucoma Medications During Videotaped Medical Visits

We applied the ecologic model of communication in medical consultations to examine how patient, physician, and situational/contextual factors are associated with whether patients ask one or more questions about glaucoma and glaucoma medications during visits to ophthalmologists. Patients with glaucoma who were newly prescribed or already on glaucoma medications were recruited at six ophthalmology clinics. Patients’ visits with their doctors were video-recorded and patients were interviewed after visits. Generalized estimating equations were used to analyze the data. Two hundred and seventy-nine patients participated. Patients asked one or more questions about glaucoma during 59% of visits and about glaucoma medications during 48% of visits. Patients who were newly prescribed glaucoma medications were significantly more likely to ask one or more questions about glaucoma and glaucoma medications. Whether providers asked patients if they had questions was not significantly associated with patient question-asking. Patients were significantly more likely to ask older providers questions about glaucoma medications and female providers questions about glaucoma. Eye care providers should encourage glaucoma patients to ask questions during their medical visits.

Achieving visibility? Use of non‐verbal communication in interactions between patients and pharmacists who do not share a common language

Despite the seemingly insatiable interest in healthcare professional–patient communication, less attention has been paid to the use of non-verbal communication in medical consultations. This article considers pharmacists′ and patients′ use of non-verbal communication to interact directly in consultations in which they do not share a common language. In total, 12 video-recorded, interpreted pharmacy consultations concerned with a newly prescribed medication or a change in medication were analysed in detail. The analysis focused on instances of direct communication initiated by either the patient or the pharmacist, despite the presence of a multilingual pharmacy assistant acting as an interpreter. Direct communication was shown to occur through (i) the demonstration of a medical device, (ii) the indication of relevant body parts and (iii) the use of limited English. These connections worked to make patients and pharmacists visible to each other and thus to maintain a sense of mutual involvement in consultations within which patients and pharmacists could enact professionally and socially appropriate roles. In a multicultural society this work is important in understanding the dynamics involved in consultations in situations in which language is not shared and thus in considering the development of future research and policy.

Emotional communication in medical consultations with native and non-native patients applying two different methodological approaches

ObjectiveTo explore the potential agreement between two different methods to investigate emotional communication of native and non-native patients in medical consultations. MethodsThe data consisted of 12 videotaped hospital consultations with six native and six non-native patients. The consultations were coded according to coding rules of the Verona Coding definitions of Emotional Sequences (VR-CoDES) and afterwards analyzed by discourse analysis (DA) by two co-workers who were blind to the results from VR-CoDES. ResultsThe agreement between VR-CoDES and DA was high in consultations with many cues and concerns, both with native and non-native patients. In consultations with no (or one cue) according to VR-CoDES criteria the DA still indicated the presence of emotionally salient expressions and themes. ConclusionIn some consultations cues to underlying emotions are communicated so vaguely or veiled by language barriers that standard VR-CoDES coding may miss subtle cues. Many of these sub-threshold cues could potentially be coded as cues according to VR-CoDES main coding categories, if criteria for coding vague or ambiguous cues had been better specified. Practice implicationsCombining different analytical frameworks on the same dataset provide us new insights on emotional communication.

Implementing patient question-prompt lists into routine cancer care

ObjectiveTo examine the feasibility and acceptability of routine provision of patient question prompt lists (QPLs) to promote patient participation and patient–clinician communication in medical consultations. MethodsFour cancer centres across NSW, Australia (two rural, two urban) were invited to participate, involving distribution of QPLs to patients seeing a medical or radiation oncologist, or palliative care clinician. Patients rated their satisfaction after their next consultation. Cancer specialists provided their views at the end of the study. ResultsSixty-four percent (389/606) of patients attending consultations received a QPL. Of patients offered a QPL (426), 91% accepted. Of 139 patients surveyed post-consultation, 89% reported reading the QPL and, of these, 44% referred to the QPL during the consultation at least once. All of 10 cancer specialists providing their views post-implementation reported that QPL implementation in routine practice was feasible and did not strain resources. ConclusionsCancer patients and cancer specialists showed support for routine dissemination of the QPL. Practice implicationsFor successful implementation of evidence-based tools we recommend promotion by local clinical champions, negotiation with clinic staff about dissemination methods, raised patient awareness through on-site project facilitators, media, consumer and support groups, and availability of resources in hard copy and via online sources.

Doctors'non-verbal behaviour in consultations: look at the patient before you look at the computer

Verbal communication in medical consultations is well recognised as being important to the delivery of medical care and is usually easy to interpret and analyse. It is discrete with clear endpoints, it occurs in a single mode, it is mostly under voluntary control, and communicates our cognitive thoughts more than our emotions. In contrast, non-verbal communication is less easy to interpret: it is continuous even in silence, can occur in several modes at once, operates at a less conscious level, leaks spontaneous cues, and is the channel most responsible for communicating attitudes, emotions, and affect.1,2 We should not be surprised, therefore, that non-verbal communication plays a significant role throughout the medical interview and is an important variable in doctor-patient interactions. Non-verbal communication helps to build the relationship, provides cues to underlying unspoken concerns and emotions, and helps to reinforce or contradict our verbal comments.3 Non-verbal communication is at its most significant in the medical interview if it contradicts the message from verbal communication. When the two are inconsistent or contradictory, non-verbal messages tend to override verbal messages.3 This explains why a closed question accompanied by effective non-verbal communication will often lead to an open answer, and why patients do not necessarily believe a reassuring verbal comment if accompanied by contradictory facial expressions and vocal hesitancy. Two intimately related aspects of non-verbal communication in the interview require consideration: the non-verbal behaviour of patients and the non-verbal behaviour of doctors. As doctors, we need to recognise and explore patients' non-verbal cues in their speech patterns, facial expressions, and body posture. But we need to be equally aware of our own non-verbal behaviour: how the doctor's use of eye contact, body position and posture, movement, facial expression, and use of voice can all influence the success of the …

A theory‐based proposal to evaluate patient‐centred communication in medical consultations

PurposeThe prupose of this paper is to present the development of the Verona Patient‐Centred Communication Evaluation (VR‐COPE) scale, together with its psychometric properties. The nine item rating scale assesses the content and relational aspects of patient‐centred communication during medical consultations on the basis of a multidimensional evaluation as suggested by the more recent literature in the field. Each item is defined by operational definitions.Design/methodology/approachA sample of 246 transcribed primary care consultations was rated with the VR‐COPE. Explorative factor analysis, Pearson correlation coefficients and internal consistency using Cronbach's alpha were calculated. Convergent validity with the Verona Medical Interview Classification System (VR‐MICS) was also tested. A sub sample of 32 consultations was used to assess inter‐rater reliability.FindingsInterrater reliability and internal consistency were good (overall Cronbach alpha=0.75). Four factors (explaining 74 per cent of the variance) were extracted by exploratory factor analysis. Six items of the VR‐COPE correlated significantly with specific communication skills evidenced by the VR‐MICS and pertained to the physician's ability to explore medical or psychosocial issues. The VR‐COPE items on interview structure and shared decision, more related to process than to specific skills, had no equivalent in the VR‐MICS.Originality/valueThe new rating scale responds to the need in communication research for a multidimensional scale that combines the evaluation of specific skills and process aspects.

Evaluation of a patient education leaflet designed to improve communication in medical consultations

It is important for patients to provide relevant information to the doctor in consultation and to make their own information requirements known. This requires patients to actively participate in the process, something they appear to be reluctant to do. Earlier patient intervention studies have successfully manipulated patient involvement and question asking, although, the latter has tended to be accompanied by increased tension and negative impact. The present study uses a patient education leaflet which uses a wide definition of patient activation. It emphasizes the role of the ‘good’ patient as a provider of information extending beyond the recitation of symptoms to include insights to interpretation and meaning. Results showed that patients responded positively to the leaflet and a comparison of doctor ratings of communication quality showed the experimental group performed better than the controls. The finding are considered in terms of improved information exchange and the impact of making the ‘rules’ of consultation explicit is also discussed.

Analyzing communication in medical consultations. Do behavioral measures correspond to patients' perceptions?

When analyzing relationships between physician-patient communication and medical outcomes, researchers typically rely on quantitative measures of behavior (e.g., frequencies or ratios) derived from observer-coding of transcripts, audiotapes, or videotapes. Interestingly, rarely have researchers assessed whether quantitative measures of communication (e.g., the physician's information giving) correspond to patients' perceptions of physicians' communication (e.g., informative). This investigation of 115 pediatric consultations examined this issue and yielded several notable findings. First, less satisfied parents received more directives and proportionally less patient-centered utterances from physicians than did more satisfied parents. Second, findings were mixed regarding the degree to which behavioral measures related to analogue measures of parents' perceptions. For example, the doctors' use of patient-centered statements was predictive of parents' perceptions of physicians' interpersonal sensitivity and partnership building, but the amount of information physicians provided parents was unrelated to judgments of the doctors' informativeness. Third, with some important exceptions, relationships between behavioral measures and parents' evaluations did not vary for parents differing in education and anxiety about the child's health. Finally, behavioral measures in the form of frequencies tended to be better predictors of parents' perceptions than were measures in the form of proportions. Implications are discussed.

Communication in medical consultations: A review essay

COMMUNICATING WITH MEDICAL PATIENTS. Edited by Moira Stewart and Debra Roter. Newbury Park, CA: Sage, 1989; pp. 286. $35.00, paper $16.50. COMMUNICATING WITH PATIENTS: IMPROVING COMMUNICATION, SATISFACTION, AND COMPLIANCE. By Philip Ley. London: Croon Helm, 1988; pp. xviii + 210. $47.50, paper $17.95. INTIMATE ADVERSARIES: CULTURAL CONFLICT BETWEEN DOCTORS AND WOMEN PATIENTS. By Alexandra D. Todd. Philadelphia: University of Pennsylvania Press, 1989; pp. 167. $29.95, paper $16.95.