Introduction to patient-practitioner interpersonal skills

In medical consultations, both patients and practitioners use a mix of verbal and non-verbal skills to communicate effectively. Verbal communication involves spoken words, such as questions about symptoms or explanations of treatments. Non-verbal communication includes unspoken signals, like body language or tone of voice. These skills are essential because they help build trust and ensure accurate understanding during interactions. Research suggests that non-verbal cues can be more influential than words alone, but they work best when they align with what is being said. For instance, if a practitioner's words are reassuring but their expression shows worry, this mismatch can erode a patient's confidence.

Non-verbal communication in consultations

Non-verbal communication refers to the exchange of information without words, through cues like gestures or facial expressions. It plays a major role in medical settings because it can convey emotions or attitudes more powerfully than speech. When non-verbal signals contradict verbal messages, it can lead to confusion or loss of trust.

Key types of non-verbal communication

• Facial expressions - These are movements of the face that show emotions, such as smiling or frowning. Patients might scan a practitioner's face for hints about their diagnosis, while practitioners use them to assess how a patient is reacting to news.
• Paralanguage - This covers the non-word elements of speech, including tone, pitch, volume, speed, and fillers like 'um' or 'er'. A bored tone might make a patient feel dismissed or unimportant.
• Personal space - This is the physical distance maintained between people during interactions. Practitioners often need to enter a patient's personal space for examinations, which can cause discomfort. Patients reporting greater invasion of their personal space were those who had more privacy at home and were lonelier.
• Gestures - These are hand or body movements that support communication, helping to clarify explanations. However, cultural differences mean some gestures might be misinterpreted or seen as offensive.
• Appearance - This involves how someone looks, including clothing and grooming. A practitioner's outfit can influence a patient's perception of their professionalism and reliability.

Research on non-verbal communication: McKinstry (1991)

This study examined how doctors' clothing affects patients' respect and comfort levels, focusing on different styles to see which were most acceptable.

Method

• Involved 475 patients of 30 doctors from five Scottish practices.
• Participants completed a questionnaire on five separate occasions.
• They viewed photographs: five of a male doctor (in a white coat, suit, tweed jacket, cardigan, or jeans) and three of a female doctor (in a white coat, skirt, or trousers).
• Questions asked which doctor they would prefer to see for the first time, their confidence level in each, how similar the photos were to their own doctor, and opinions on the clothing.

Results

• Patients gave the highest acceptability scores to conservative clothing: 50% rated the male doctor in a suit as top, 38% for the white coat; for females, 55% preferred the white coat and 47% the skirt.
• Older patients favoured formal attire more, such as suits and white coats.
• 64% of participants said clothing was very or quite important, while 36% found it unimportant.
• Some choices matched the clothing of their own doctors.

Conclusions

• Patients tend to prefer doctors in conservative dress.
• Doctors might choose certain styles to gain patients' approval.

Evaluation

• Strengths - The use of photographs of unfamiliar doctors increased validity by avoiding bias from personal experiences. Questionnaires provided reliable quantitative data through closed questions.
• Limitations - The sample was limited to one Scottish region, reducing generalisability to other areas or demographics. More photos of male doctors than females, and no female in a suit, might have skewed results towards white coats as the most formal option.

Verbal communication in consultations

Verbal communication is the use of spoken words to exchange information, such as a practitioner asking about symptoms or explaining a diagnosis. It is crucial for clear understanding but can be affected by how information is delivered.

Factors influencing verbal communication

• Primacy effect - This is a cognitive bias where information presented first is remembered better and stored in long-term memory, while later details may be forgotten.
• Forgetting - Patients often retain only a small portion of what is said; studies show they might remember as little as 20% and immediately forget between 40-80%.
• Medical terminology - Complex terms can confuse patients, especially if not explained, leading to misunderstandings about conditions or instructions.

Research on verbal communication: McKinlay (1975)

This study explored how well working-class women understood medical terms used by practitioners in obstetrics and gynaecology settings.

Method

• Participants - 87 unskilled working-class women attending appointments, divided into 'utilisers' (frequent users of services) and 'underutilisers' (less frequent).
• Procedure - Presented with a list of 13 medical words spoken aloud and then in sentences. Participants explained the meanings, with responses recorded verbatim and scored blindly as wrong/vague knowledge or adequate understanding.

Results

• Utilisers showed consistently higher understanding overall than underutilisers; for example, 100% of utilisers understood 'breech' compared to 84.4% of underutilisers.
• For words like 'antibiotic', 41.7% of utilisers had adequate knowledge versus 28.9% of underutilisers.
• Physicians consistently underestimated patients' comprehension.
• Many physicians still used these terms with patients despite assuming low understanding.

Conclusions

• Working-class patients often misunderstood medical terms, with underutilisers faring worse.
• Physicians frequently used jargon they assumed patients wouldn't grasp, highlighting a communication gap.

Evaluation

• Strengths - Conducted in a real clinic setting with relevant words, enhancing validity as it reflected actual experiences. Findings can improve healthcare communication practices.
• Limitations - Limited to working-class women in one field, reducing generalisability; broader samples would help. Quantitative data showed patterns but lacked qualitative insights into why misunderstandings occurred.

Methodological issues in the research

Research on interpersonal skills often uses methods like questionnaires and interviews, but these have strengths and weaknesses that affect reliability and applicability.

Issues and debates in patient-practitioner research

Application to everyday life

These studies shift focus from patient faults to practitioner responsibilities in communication. This can lead to practical changes, like training in clearer language or appropriate attire, to enhance consultations and patient outcomes.

Idiographic versus nomothetic approaches

Much of the research takes a nomothetic approach, studying groups to find general patterns, which aids in broad recommendations. However, an idiographic approach, emphasising individual experiences through qualitative methods, could better address unique needs.