Verbal and non-verbal behavior of doctors and patients in primary care consultations – How this relates to patient enablement

• Published in: Patient education and counseling 2012-01, Vol.86 (1), p.70-76
• Main Authors: Pawlikowska, Teresa, Zhang, Wenjuan, Griffiths, Frances, van Dalen, Jan, van der Vleuten, Cees
• Format: Article
• Language: English
• Subjects: Adult; Biological and medical sciences; Communication; Consultation; Doctors; Female; Health Status Indicators; Humans; Interaction analysis; Internal Medicine; Kinesics; Logistic Models; Male; Medical sciences; Middle Aged; Miscellaneous; Models, Psychological; Non-verbal communication; Nursing; Patient centredness; Patient enablement; Patient-Centered Care; Patient–physician relationship; Personal Autonomy; Physician-Patient Relations; Power (Psychology); Primary care; Primary health care; Primary Health Care - methods; Psychometrics; Public health. Hygiene; Public health. Hygiene-occupational medicine; Qualitative Research; Referral and Consultation; Socioemotional aspects; Verbal Behavior; Verbal communication
• ISSN: 0738-3991; 1873-5134
• DOI: 10.1016/j.pec.2011.04.019

Abstract Objective To assess the relationship between observable patient and doctor verbal and non-verbal behaviors and the degree of enablement in consultations according to the Patient Enablement Instrument (PEI) (a patient-reported consultation outcome measure). Methods We analyzed 88 recorded routine primary care consultations. Verbal and non-verbal communications were analyzed using the Roter Interaction Analysis System (RIAS) and the Medical Interaction Process System, respectively. Consultations were categorized as patient- or doctor-centered and by whether the patient or doctor was verbally dominant using the RIAS categorizations. Results Consultations that were regarded as patient-centered or verbally dominated by the patient on RIAS coding were considered enabling. Socio-emotional interchange (agreements, approvals, laughter, legitimization) was associated with enablement. These features, together with task-related behavior explain up to 33% of the variance of enablement, leaving 67% unexplained. Thus, enablement appears to include aspects beyond those expressed as observable behavior. Conclusion For enablement consultations should be patient-centered and doctors should facilitate socio-emotional interchange. Observable behavior included in communication skills training probably contributes to only about a third of the factors that engender enablement in consultations. Practice implications To support patient enablement in consultations, clinicians should focus on agreements, approvals and legitimization whilst attending to patient agendas.