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Research

Verbal and non-verbal behaviour and patient perception of communication in primary care: an observational study

Paul Little, Peter White, Joanne Kelly, Hazel Everitt, Shkelzen Gashi, Annemieke Bikker and Stewart Mercer
British Journal of General Practice 2015; 65 (635): e357-e365. DOI: https://doi.org/10.3399/bjgp15X685249
Paul Little
Primary Care Group, Primary Care and Population Sciences Unit, Faculty of Medicine, University of Southampton, Southampton.
Roles: Professor of primary care research
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Peter White
Nightingale Surgery, Romsey.
Roles: GP
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Joanne Kelly
Primary Care Group, Primary Care and Population Sciences Unit, Faculty of Medicine, University of Southampton, Southampton.
Roles: Study manager
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Hazel Everitt
Primary Care Group, Primary Care and Population Sciences Unit, Faculty of Medicine, University of Southampton, Southampton.
Roles: Associate professor
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Shkelzen Gashi
Primary Care Group, Primary Care and Population Sciences Unit, Faculty of Medicine, University of Southampton, Southampton.
Roles: Medical student
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Annemieke Bikker
General Practice & Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow.
Roles: Research associate
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Stewart Mercer
General Practice & Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow.
Roles: Professor of primary care research
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Abstract

Background Few studies have assessed the importance of a broad range of verbal and non-verbal consultation behaviours.

Aim To explore the relationship of observer ratings of behaviours of videotaped consultations with patients’ perceptions.

Design and setting Observational study in general practices close to Southampton, Southern England.

Method Verbal and non-verbal behaviour was rated by independent observers blind to outcome. Patients competed the Medical Interview Satisfaction Scale (MISS; primary outcome) and questionnaires addressing other communication domains.

Results In total, 275/360 consultations from 25 GPs had useable videotapes. Higher MISS scores were associated with slight forward lean (an 0.02 increase for each degree of lean, 95% confidence interval [CI] = 0.002 to 0.03), the number of gestures (0.08, 95% CI = 0.01 to 0.15), ‘back-channelling’ (for example, saying ‘mmm’) (0.11, 95% CI = 0.02 to 0.2), and social talk (0.29, 95% CI = 0.4 to 0.54). Starting the consultation with professional coolness (‘aloof’) was helpful and optimism unhelpful. Finishing with non-verbal ‘cut-offs’ (for example, looking away), being professionally cool (‘aloof’), or patronising, (‘infantilising’) resulted in poorer ratings. Physical contact was also important, but not traditional verbal communication.

Conclusion These exploratory results require confirmation, but suggest that patients may be responding to several non-verbal behaviours and non-specific verbal behaviours, such as social talk and back-channelling, more than traditional verbal behaviours. A changing consultation dynamic may also help, from professional ‘coolness’ at the beginning of the consultation to becoming warmer and avoiding non-verbal cut-offs at the end.

  • communication
  • consultation
  • general practice
  • non-verbal communication
  • Received August 23, 2014.
  • Revision requested October 6, 2014.
  • Accepted November 13, 2014.
  • © British Journal of General Practice 2015
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British Journal of General Practice: 65 (635)
British Journal of General Practice
Vol. 65, Issue 635
June 2015
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Verbal and non-verbal behaviour and patient perception of communication in primary care: an observational study
Paul Little, Peter White, Joanne Kelly, Hazel Everitt, Shkelzen Gashi, Annemieke Bikker, Stewart Mercer
British Journal of General Practice 2015; 65 (635): e357-e365. DOI: 10.3399/bjgp15X685249

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Verbal and non-verbal behaviour and patient perception of communication in primary care: an observational study
Paul Little, Peter White, Joanne Kelly, Hazel Everitt, Shkelzen Gashi, Annemieke Bikker, Stewart Mercer
British Journal of General Practice 2015; 65 (635): e357-e365. DOI: 10.3399/bjgp15X685249
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    • Abstract
    • INTRODUCTION
    • METHOD
    • RESULTS
    • DISCUSSION
    • Acknowledgments
    • Appendix 1. Variables associated with patient rating of health promotion
    • Appendix 2. Variables associated with patient rating of the doctor being positive about the problem and its natural history
    • Appendix 3. Variables associated with patient rating of enablement
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Keywords

  • communication
  • consultation
  • general practice
  • non-verbal communication

More in this TOC Section

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  • Antimicrobial stewardship in the UK during the COVID-19 pandemic: a population-based cohort study and interrupted time-series analysis
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