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Emerald Group Publishing Limited
Copyright © 2008, Emerald Group Publishing Limited
Improving provider-patient communication is not an option, but a necessity
Article Type: Guest editorial From: Health Education, Volume 108, Issue 5
The medical interview has three main functions: for the patient to narrate to the physician symptoms and relevant concerns, for the physician to learn about the patient’s condition, and to work out a treatment plan which may include recommendations to the patient about behavioral change to prevent further health problems. This special issue gathers five papers based on empirical research examining verbal and nonverbal communication between health providers and patients, sampled from The Netherlands, Italy, Estonia, Poland, Romania, the USA, and Canada. It is coincidental that two of the five studies use the Roter Interactional Analysis System (RIAS) to code communicative behaviors and a third study presenting a new coding system, the Verona Patient-Centred Communication Rating Scale (VR-COPE). Although RIAS has been widely used and well-accepted in the field, it has its limitations. It was time for the field to try a new scale. One reviewer, a well-established researcher and long-time user of RIAS, offers the following comments:
I was prepared to be critical of this paper because a great deal of measures development has taken place already. Why create just another measurement/evaluation tool? However, as I read this paper I was convinced of its value to the international literature for these reasons: the attention to overcoming difficulties of past rating scales; and the distinction between content, skills and process.
In VR-COPE, content aspects capture patient’s beliefs, opinions and ideas on illness or symptoms. Skills refer to communicative competency such as physician’s ability to respond to patient emotions and checking for understanding. Process concerns openness and feelings, the way of structuring the consultation and orienting the patient. The VR-COPE paper is contributed by Lidia Del Piccolo, Maria Angela Mazzi, Silvia Scardoni, Martina Gobbi, and Christa Zimmermann. Like any new scale, whether VR-COPE can stand the test of time remains to be seen. I wish the authors the best of luck.
J. Bensing, W. Verheul and A.M. van Dulmen report a study on verbal and nonverbal communication between 142 Dutch GPs and 2,095 adult patients. They find that worries are not openly expressed in more than half of the consultations, not even by patients with high levels of anxiety. Patients tend to express their concerns in a more indirect way, partly by verbal, partly by nonverbal signals. The question raised is: how do GPs facilitate patients to express their concerns more openly? The answer: by showing verbal and nonverbal affect to the patient, not by direct questioning. In other words, GPs need to have the ability and intention to make patients feel comfortable and trusting before patients open up to them. This achievement in turn, is crucial for GPs to obtain essential information to reach correct diagnoses and for patients to receive quality care.
Comparison of the communication styles in primary health care in Europe is the focus of Atie van den Brink-Muinen, Heidi-Ingrid Maaroos and Heli Tähepõld. Their multi-nation study illustrates that physician-patient communication, like any other human interaction, occurs in a cultural context. Evident cultural differences are present in the way physicians and patients communicate. For example, in Romania, physician-patient talk has more psychosocial ingredients than in Poland and Estonia, whereas in the latter two countries, physician-patient talk has more emphasis on biomedical issues. Interestingly, they find that the GPs in the new EU-countries mainly rely on verbal messages to communicate with their patients, while GPs in the old EU-countries rely on both verbal and nonverbal messages.
D.L. Roter, L.H. Erby, J.A. Hall, S. Larson, L. Ellington, and W. Dudley find evidence that nonverbal sensitivity of both counselors and clients contributes positively to clients’ knowledge acquisition and ratings of session satisfaction, providing valuable information for increasing the effectiveness of future health education activities. Furthermore, they find a strong relationship between ethnicity of clients and their nonverbal sensitivity scores: African Americans score significantly lower on both video and audio tests than do Caucasians, indicating that nonverbal cues and their detection are highly culture-sensitive. It can be argued that when the ethnicity of providers and clients is not matched, communication difficulties could occur resulting in negative consequences on the quality of health care.
Han Li, Zhi Zhang, Young-Ok Yum, Juanita Lundgren, and Jasrit Pahal examine interruption patterns in 40 resident-patient interviews in a Canadian clinic. Although interruptions have been studied extensively in medical interviews, the relationship between patient satisfaction and interruption has not. They find that patient satisfaction is negatively correlated with residents’ intrusive interruptions and positively correlated with residents’ cooperative interruptions. The implication to health providers is that they can interrupt patients without risking their relationship with them, but need to use good judgment as to how to interrupt. This study also finds evidence for the patient participation model in that patient satisfaction is higher among those who make more cooperative interruptions.
Taken together, the five research papers point out that improving provider-patient communication is not an option, but a necessity.
Han Z. LiPsychology Program, University of British Columbia, Prince George, Canada.