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Verbal and non-verbal behavior of doctors and patients in primary care consultations – How this relates to patient enablement
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Pawlikowska, T., Zhang, Wenjuan, Griffiths, Frances, Dalen, Jan van and Vleuten, C. van der (Cees) (2012) Verbal and non-verbal behavior of doctors and patients in primary care consultations – How this relates to patient enablement. Patient Education and Counseling, 86 (1). pp. 70-76. doi:10.1016/j.pec.2011.04.019 ISSN 0738-3991.
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Official URL: http://dx.doi.org/10.1016/j.pec.2011.04.019
Abstract
Objective: To assess the relationship between observable patient and doctor verbal and non-verbal behaviors and the degree of enablement in consultations according to the Patient Enablement Instrument (PEI) (a patient-reported consultation outcome measure).
Methods: We analyzed 88 recorded routine primary care consultations. Verbal and non-verbal communications were analyzed using the Roter Interaction Analysis System (RIAS) and the Medical Interaction Process System, respectively. Consultations were categorized as patient- or doctor-centered and by whether the patient or doctor was verbally dominant using the RIAS categorizations.
Results
Consultations that were regarded as patient-centered or verbally dominated by the patient on RIAS coding were considered enabling. Socio-emotional interchange (agreements, approvals, laughter, legitimization) was associated with enablement. These features, together with task-related behavior explain up to 33% of the variance of enablement, leaving 67% unexplained. Thus, enablement appears to include aspects beyond those expressed as observable behavior.
Conclusion: For enablement consultations should be patient-centered and doctors should facilitate socio-emotional interchange. Observable behavior included in communication skills training probably contributes to only about a third of the factors that engender enablement in consultations.
Practice implications:
To support patient enablement in consultations, clinicians should focus on agreements, approvals and legitimization whilst attending to patient agendas.
| Item Type: | Journal Article | ||||
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| Subjects: | R Medicine > R Medicine (General) R Medicine > RA Public aspects of medicine |
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| Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences > Social Science & Systems in Health (SSSH) |
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| Library of Congress Subject Headings (LCSH): | Physician and patient, Nonverbal communication, Medical consultation | ||||
| Journal or Publication Title: | Patient Education and Counseling | ||||
| Publisher: | Elsevier Science BV | ||||
| ISSN: | 0738-3991 | ||||
| Official Date: | 2012 | ||||
| Dates: |
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| Volume: | 86 | ||||
| Number: | 1 | ||||
| Page Range: | pp. 70-76 | ||||
| DOI: | 10.1016/j.pec.2011.04.019 | ||||
| Status: | Peer Reviewed | ||||
| Publication Status: | Published | ||||
| Access rights to Published version: | Restricted or Subscription Access | ||||
| Funder: | Warwick Medical School Research Development Grant | ||||
| Grant number: | MD001 (WMS) |
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