Pawlikowska, T., Zhang, Wenjuan, Griffiths, Frances, Dalen, Jan van and Vleuten, C. van der (Cees). (2011) Verbal and non-verbal behavior of doctors and patients in primary care consultations – How this relates to patient enablement. Patient Education and Counseling . ISSN 07383991

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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
Subjects:	R Medicine > R Medicine (General) R Medicine > RA Public aspects of medicine
Divisions:	Faculty of Medicine > Warwick Medical School
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:	07383991
Date:	2011
Identification Number:	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)
URI:	http://wrap.warwick.ac.uk/id/eprint/39976

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