ABCDE in Clinical Encounters: Presentations of Self in Doctor-Patient Communication

Abstract

Professional discussions about communication in medical settings often ignore the various personal identities that doctors and patients bring to their clinical encounters. From my 26 years as a family physician, and informed by literature from other professional disciplines, I propose an alternate understanding: to think of doctors and patients as a collection of individual identities, each formed by a discrete presentation of self. I describe how at least 5 important presentations of self arise in clinical encounters, including those relating to meaning, community, agency, anxiety, and organism. I frame these presentations of self with the mnemonic ABCDE, briefly review key dimensions of each, and suggest how physicians can reflect on these dimensions in order to find equilibrium in their interactions with patients. Lastly, I submit that finding this balance can reduce relational challenges with patients and enhance the therapeutic effectiveness of doctor-patient communication.

Exploring the COMFORT Model for Complex Communication for Physiotherapists in Neurorehabilitation: A Critical Review

“…The current study employed a self-efficacy theory approach due to low confidence reported from many physiotherapists as an influential factor 6 in avoiding interaction with patients while establishing a biomedical discourse in the clinical encounters [28][29][30]. To clarify, when individuals feel confident about their abilities (self-efficacy), they are more likely to reach their goals [35,36].…”

“…Most notably in the field of oncology where the dilemma of giving hope in a bleak situation is obvious [36]. Of the numerous frameworks available including the SPIKES protocol, the SHARE model, the ABCDE mnemonic and the BREAKS protocol, the COMFORT model possibly aligns best with PCC in terms of neurorehabilitation [28,29,34,41].…”

“…Competent communication requires skills that embrace being compassionate and empathetic [26,27]. The ongoing process of rehabilitation requires tackling whether delivering bad news or unfavorable prognosis with confidence [28][29][30]. Further challenges are responding to the patient's level of understanding either from health literacy levels or cultural differences and dealing with concerns and fears from either patients or relatives [12,[31][32][33][34].…”

Building Power Between Polarities

“…Expressions such as, “Tell me more” and “I don’t understand” invite others to examine underlying attitudes. Know that people’s self-identities have various facets and may take varied forms as they are expressed in conversation (Ventres, 2015a). …”

In This Issue: A Cry for Balance

“…He describes how balancing these individual identities can reduce relational challenges and enhance communication effectiveness. 14 De Schweinitz introduces readers to a particular patient for whom knowing the story and deepening the conversation did not guarantee change, but served as a reminder of the core values of patience, humility, and faith. 15 And a story from an impoverished outreach clinic in Beirut reminds a young physician of the meaning of her profession.…”