Brush up your communication skills
Doctor- and patient-centeredness
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Two polar types of consultation style have been identified, based on video-recordings of consultations; these have been designated ‘doctor-centred’ and ‘patient-centred’ (Byrne & Long 1976).
The following explanation is modified from Morgan (2003).
Doctor-centred approach
A doctor-centred consultation is based on the assumption that the doctor is the expert and the patient merely required to cooperate.
Doctors adopting this approach focus on the physical aspects of the patients’ disease and employ tightly controlled interviewing methods to elicit the necessary medical information.
Questions are thus mainly of a ‘closed’ nature, such as ‘how long have you had the pain?’ and ‘is it sharp or dull?’. These questions aim to provide information to enable the doctor to interpret the patient’s illness within his or her own biomedical disease framework, while providing little opportunity for patients to express their own beliefs and concerns.
Patient-centred approach
At the other end of the continuum are doctors whose consultation style conforms to a ‘patient-centred’ approach.
These doctors adopt a much less controlling style and encourage and facilitate their patients to participate in the consultation, thus fostering a relationship of ‘mutuality’.
An important feature of this approach is the greater use of ‘open’ questions, such as ‘tell me about the pain’, ‘how do you feel?’ and ‘what do you think is the cause of the problem?’.
This approach also requires that doctors spend more time actively listening to patients’ problems through picking up and responding to patient cues, encouraging patients to express their own ideas or feelings, clarifying and interpreting patients’ statements, and generally using a more participative style with the various options presented and discussed with patients.
Think
Which approach do you normally use?
Studies show that individual doctors can be classified fairly consistently as holding either doctor-centred or patient-centred consultations. This suggests that doctors develop a particular consulting style and do not vary this significantly in relation to the patient’s problems.
However, doctors classified as having a patient-centred style tend to be the most flexible, showing the greatest ability to respond to differences in patients’ needs or the circumstances of the consultation.
I suggest that a patient-centred approach will help you consult in a way that meets both your needs and those of your patients.
The next page looks at one quick, effective way of doing this.
Next page: Ideas, concerns and expectations
Study guide by: Michael Harris.
Last updated: 12 August 2007