Identifying context factors explaining physician's low performance in communication assessment: an explorative study in general practice

Abstract

BackgroundCommunication is a key competence for health care professionals. Analysis of registrar and GP communication performance in daily practice, however, suggests a suboptimal application of communication skills. The influence of context factors could reveal why communication performance levels, on average, do not appear adequate. The context of daily practice may require different skills or specific ways of handling these skills, whereas communication skills are mostly treated as generic. So far no empirical analysis of the context has been made. Our aim was to identify context factors that could be related to GP communication.MethodsA purposive sample of real-life videotaped GP consultations was analyzed (N = 17). As a frame of reference we chose the MAAS-Global, a widely used assessment instrument for medical communication. By inductive reasoning, we analyzed the GP behaviour in the consultation leading to poor item scores on the MAAS-Global. In these cases we looked for the presence of an intervening context factor, and how this might explain the actual GP communication behaviour.ResultsWe reached saturation after having viewed 17 consultations. We identified 19 context factors that could potentially explain the deviation from generic recommendations on communication skills. These context factors can be categorized into doctor-related, patient-related, and consultation-related factors.ConclusionsSeveral context factors seem to influence doctor-patient communication, requiring the GP to apply communication skills differently from recommendations on communication. From this study we conclude that there is a need to explicitly account for context factors in the assessment of GP (and GP registrar) communication performance. The next step is to validate our findings.

‘No need to worry’: an exploration of general practitioners’ reassuring strategies

“…Thus, GPs seemed to tailor their reassurance to the context of that specific consultation, which explains why they described such a wide variety of strategies. The context-specific and goal-directed character of doctor-patient communication has also been shown in previous research [27,40,41]. The situation-specificity of reassurance has also been demonstrated in our study exploring the patients’ perspective on reassurance, which showed that what is experienced as reassuring by patients largely depends on their specific worrying cognitions [38].…”

‘I still have no idea why this patient was here’: An exploration of the difficulties GP trainees experience when gathering information

“…Trainees' reflections on situations during which the skills they have learned during medical training are ineffective, again underline that the context-specific nature of medical communication in daily practice should not be ignored [27][28][29][30]. In line with previous studies, there seems to be a need for more tailored, context-specific communication strategies that are adaptable to specific situations [31,32].…”

Mixed messages in learning communication skills? Students comparing role model behaviour in clerkships with formal training

“…In order to learn from their experiences, the need for debriefing and for discussion throughout the clerkships seems high, considering the impact of this form of learning (Egnew & Wilson 2011) and contextual influences on communication (Bensing et al 2003, Essers et al 2011. However, in a recent study, Wouda and van de Wiel (2012) found that there is no substantial increase in student communication levels from clerkships.…”

“…Recent literature shows that such context factors influence communication patterns (MacDonald & Green 2001;Bensing et al 2003;Hawken 2005;Yamkovenko & Holton 2010;Essers et al 2011). Although students value patient centredness and want to learn about Practice points .…”