How doctors move from generic goals to specific communicative behavior in real practice consultations

• Published in: Patient education and counseling 2013-02, Vol.90 (2), p.170-176
• Main Authors: Veldhuijzen, Wemke, Mogendorff, Karen, Ram, Paul, van der Weijden, Trudy, Elwyn, Glyn, van der Vleuten, Cees
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Attitude of Health Personnel; Child; Child, Preschool; Clinical Competence; Communication; Consultation; Context of communication; Doctors; Family Practice - methods; Family Practice - organization & administration; Female; General practice; Goals; Grounded theory; Humans; Internal Medicine; Interviews as Topic; Male; Medical education; Middle Aged; Models, Psychological; Models, Theoretical; Nursing; Physician's Role; Physician-Patient Relations; Physicians - psychology; Post-graduate education; Practice Patterns, Physicians; Qualitative Research; Recording; Referral and Consultation; Revisions; Time Factors; Young Adult
• ISSN: 0738-3991; 1873-5134
• DOI: 10.1016/j.pec.2012.10.005

Abstract Objective To understand how recommendations for communication can be brought into alignment with clinical communication routines, we explored how doctors select communicative actions during consultations. Methods We conducted stimulated recall interviews with 15 GPs (general practitioners), asking them to comment on recordings of two consultations. The data analysis was based on the principles of grounded theory. Results A model describing how doctors select communicative actions during consultations was developed. This model illustrates how GPs constantly adapt their selection of communicative actions to their evaluation of the situation. These evaluations culminate in the selection of situation-specific goals. These multiple and often dynamic goals require constant revision and adaptation of communication strategies, leading to constant readjustments of the selection of communicative actions. When selecting consultation goals GPs weigh patients’ needs and preferences as well as the medical situation and its consequences. Conclusions GPs’ selection of communicative actions during consultations is situational and goal driven. Practice implications To help doctors develop communicative competence tailored to the specific situation of each consultation, holistic communication training courses, which pay attention to the selection of consultation goals and matching communication strategies besides training specific communication skills, seem preferable to current generic communication skills training.