The Patient Practitioner Relationship

Video feedback for medical students.

Maguire and Rutter used medical feedback with medical students to try and improve communication with patients. They used two groups of medical students, the video group and the control group. The video groupsawa video of an interview they conducted with a patient and were given guidence on their interviewing technique. The control group had no video feedback or guidence. One week later all students interviewed a second patient. The results were that those in the video group gained 3 times as much information from patients than the control group.

In conclusion communication skills are very important for correct diagnosis and treatment.

An implication for the future would be to include video feedback in medical student training.

Medical and everyday language.

Bouris et al examined the use of medical and everyday language between 40 doctors 40 nurses and 40 patients. They used questionnaires containing 7 point Likert scales of appropriateness ofthe use of ML and EL in a hospital setting between all 3 groups. Questions about background information and attitudes to communication issues in the hospital were also included. The results were that the doctors believed that they used EL but the nurses and patients disagreed. Patients used EL for better communication with the doctors. The doctors didn't encourage patients to use ML. The nurses acted as communication brokers as they translated ML to EL. All groups agreed that EL was better for use with the patients and all groups agreed that ML leads to communication difficulties.

In conclusion the doctors use ML as a way of maintaining status while the nurses are less status conscious.

An implication for the future would be for hospital staff to find ways to improve communication with patients without using ML.

Consulting style and patient satisfaction.

Savage et al looked at the doctor's consulting style and the effect on patient satisfaction. They used 200 participants from a London GP. The consultations were tape recorded and then the participants were given questionnaires about their experience, one immediately afterwards and one a week later. When in the consultation the particapant received one of two consultation styles: directed (you are suffering from...) and sharing (what do you think is wrong?). The results showed that the directed consultation had higher levels of patient satisfaction.

So in conclusion the directed consulation should be used to gain higher levels of patient satisfaction.

An implication for the future would be for doctors to give patients a choice of how their consultationsare conducted when they first join the practice.

3 stages of delay in seeking medical care.

Safer et al identified 3 stages of delay in seeking medical care. 93 patients in 4 US clinics were approached in a waiting room and were interviewed by a black female nurse and a male undergraduate. They were asked questions about each stage of possible delay: 1. appraised delay (the time taken to recognise a symptom as a sign of illness) 2. illness delay (the time taken from deciding one is ill to deciding to seek medical care) 3. utilisation delay (the time taken from deciding to seek medical care and actually getting it). The results were that the mean total delay was 14.2 days. There was a relationshipbetween appraised delay and severe pain/bleeding. Illness delay correlated with having the symptom before, negative consequences and gender - females delayed longer. Utilisation delay correlated with cost, pain and belief that illness could be cured.

In conclusion different factors intervene at each of the different stages so total delay is a less useful measure.

An implication for the future would be for the doctors to know how long the patient has delayed so they know what treatment to give them.