Patterns of interaction in doctor-patient communication and their impact on health outcomes
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- The Usage-Based Study of Language Learning and Multilingualism, 2016, pp. 235 - 254
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© 2016 by Georgetown University Press. All rights reserved. Studies across the world have demonstrated that effective communication is fundamental to the delivery of safe and high-quality health care. However, identifying the direct relationship between effective communication and patient health outcomes that can affect patient safety has proved more problematic. This chapter reports on research into authentic communication between doctors and patients during consultations in an Accident and Emergency Department (AED) at a Hong Kong hospital. It is part of a wider study of communication within the AED that combined ethnographic observations, interviews with clinicians and patients, and audio recordings of ten patient journeys from triage to disposition. The primary focus here is on how information is exchanged and relationships are developed in the doctor-patient consultations of two patients in the AED. One consultation we characterize as effective, with the patient reporting a high level of satisfaction and understanding of the diagnosis and treatment plan; the other we characterize as less effective, with the patient expressing a high degree of dissatisfaction with the doctor and indicating that she would not comply with the recommended treatment. Recognizing that communication has both interpersonal and experiential dimensions, we analyze the discourse of the two consultations in terms of both move and speech function-which realize interpersonal meanings-and in terms of lexis, which realize experiential meanings. By demonstrating the interdependency of these two dimensions of meanings, our analyses show clear differences between the two consultations. In the less effective consultation, the patient is largely relegated to the passive speech role of answering the doctor’s mainly closed questions, and it is the doctor who mostly controls movement through the field of medically related information. In the more effective consultation, speech roles are more equally distributed, and the patient has much more control over movement through the field. We argue that the doctor-centered discourse of the less effective consultation makes it much more difficult for the patient to introduce additional information that may be relevant to the diagnosis, and to have her concerns and anxieties adequately addressed. This leads directly to the unsatisfactory outcomes of the consultation, with potential negative consequences for patient safety. Conversely, in the more patient-centered discourse of the effective consultation, the patient is able to communicate to the doctor additional information relevant to his diagnosis, and to have his concerns and issues fully discussed. This leads directly to the satisfactory outcome of the consultation and ultimately to adherence with the recommended treatment.
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