Patient-centred communication: videotaped consultations
Introduction
It is essential to study the communication between physicians and patients because of the importance of patient satisfaction and its consequences regarding compliance, outcome, and other effects concerning efficacy. In spite of financial cutbacks in the health care system, quality and effectiveness must be maintained or even improved. These factors, as well as criticism from patients, have initiated this study. Orthopaedic surgeons have rarely been studied from the point of view of communication. Most studies in this field have concerned general practitioners (GPs). The aim of the first part of the three studies [1] was to describe the patients’ experience of communication with their orthopaedic surgeons. The aim of the second study [2] was to describe orthopaedic surgeons’ experience of encounters with patients by allowing them to observe and comment on their own videotaped medical consultations. The main results were that, surprisingly often, patients did not understand what the physicians were talking about, but also that the physicians felt that it was difficult to help certain patients. Consequently, the aim of this study—the third part—is to analyse the way in which orthopaedic surgeons manage consultations, and to identify factors possibly associated with patient-experienced satisfaction/dissatisfaction.
Many studies have focused on patient satisfaction with the consultation regarding an association with compliance, symptom alleviation, and other positive effects [3], [4], [5]. In the study by Ong et al. [6] patients’ satisfaction was best predicted by information-giving by their physician. Hall et al. [7] showed that healthier patients were more satisfied with their care and that patients were more satisfied with visits to female than male physicians. Waghorn and McKee [8] found that the majority of patients (78%) at a surgical outpatient clinic did not have a preference with regard to the gender of the physician. Among those who expressed a preference, males preferred being attended by males and females by females. One study from the orthopaedic field [9] shows that patient satisfaction can be an important determinant of outcome. Patient-centredness is a concept often mentioned in the literature; including that the physician is paying attention, among other things, to the patient’s health beliefs, i.e. ideas about health, illness and management [10].
Orthopaedics is the medical speciality devoted to the diagnosis, treatment, rehabilitation and prevention of injuries and diseases of the body’s musculoskeletal system. This complex system includes bones, joints, ligaments, tendons, muscles and nerves which allow us to move, work and be active. As part of the surgical specialities, orthopaedics have a tradition of being much disease-oriented than GPs, for instance.
Section snippets
Sample and procedure
Eighteen orthopaedic consultations were videotaped at an orthopaedic outpatient clinic. Nine of the consultations were first-time visits and an equal number were follow-up consultations. In each videotaped consultation, an orthopaedic surgeon and a patient took part; thus a total of 18 physicians, 17 male, 1 female (years of age 33–63, years as specialist 1–36) and 18 patients, 10 male, 8 female (years of age 27–74) participated. All of the orthopaedic surgeons working at the clinic in question
Assessments of the four positive and seven negative consultations using the CM
According to the researchers’ assessment using the CM, four consultations were rated as positive, seven as negative, and seven were neither completely positive nor completely negative. This was in accordance with the comments of the patients.
The four positive consultations (Fig. 1) were characterised by a greater prevalence of the items ‘Sharing Understanding’ and ‘Involving’, in contrast with the seven negative consultations (Fig. 2).
On the other hand, the negative consultations (Fig. 2) were
Discussion and conclusion
The present study showed an association between satisfied patients and that the physician involves the patient in the consultation. There was also an association when the physician and patient arrive at a mutual understanding, i.e. the more ‘Sharing Understanding’ the less the patients are dissatisfied. A similar pattern was observed with regard to ‘Involving the patient’. Other studies [25] have shown that a key factor in the communication difficulties appears to be the difficulty for the
Acknowledgements
The authors are grateful to Professor Töres Theorell MD and Hans Peter Søndergaard PhD, MD for their valuable comments. This study has been financed by the Board of Research for Health and Caring Sciences, Karolinska Institutet, Stockholm, Sweden and the FoUU grant at the Orthopaedic Clinic at the Karolinska Hospital. The study has been approved by the Research Ethics Committee at Karolinska Hospital, Stockholm, Sweden.
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2016, International Journal of Nursing StudiesCitation Excerpt :However, communicative behavior may be disturbed by protocols and guidelines (Jones, 2009), by power imbalances between patients and professionals (Brämberg et al., 2012), and by conflicting values (Eldh et al., 2006). While consultations in which “sharing and understanding” and “involving the patient in management” are associated with high patient satisfaction (Fossum and Arborelius, 2004), patients sometimes feel involved when there has been objectively very little collaboration, and vice versa (Saba et al., 2006). Moreover, physicians may use different strategies when communicating with women than with men, using more indirect communication (Smith et al., 2005).
Satisfaction with and Perception of Pain Management among Palliative Patients with Breakthrough Pain: A Qualitative Study
2015, Pain Management NursingCitation Excerpt :Patients want to be more active and engaged in the process of exchanging information and be able to express their own needs. When patients are involved in the discussion, they are found to be more satisfied (Fossum & Arborelius, 2004). Healthcare providers should have better communication skills, be more understanding and empathetic, and address the needs of patients (Korhan et al., 2013; Luckett et al., 2013; Webber et al., 2011).
A systematic review of surgeon-patient communication: Strengths and opportunities for improvement
2013, Patient Education and CounselingCitation Excerpt :This means that surgeons using a dominating voice had approximately three times the odds of having a malpractice claim versus those who were not classified as using a dominating voice [43]. Four quantitative and three qualitative studies examined the association between surgeon communication and patient satisfaction [23,25,30,31,34,44,46,51] plus one companion report [46] (Table 4). Levinson found high levels of satisfaction with a difference based on race even after controlling for depression, experience with surgeon, and health status (93.4% of white versus 82.7% of African Americans were very satisfied) [51].
Complex health care decisions with older patients in general practice: Patient-centeredness and prioritization in consultations following a geriatric assessment
2013, Patient Education and CounselingCitation Excerpt :Our results also indicate that although physicians react in a patient-centered way when dealing with everyday problems, they either do not feel entitled to make (shared) decisions on priorities or simply cannot offer any solutions leading to a treatment decision in this area. Even though health related everyday topics have been shown to be very important for older patients [see 35] and even though doctors act empathically, doctors may feel more confident in making decisions on medical problems because of their specialist knowledge. In the consultations, there was little discussion about the importance of health problems and subsequent priority setting.