Introduction: Analyzing interaction between doctors and patients in primary care encounters

Maynard, Douglas W.

doi:10.1017/cbo9780511607172.003

Cited by 135 publications

(155 citation statements)

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“…303 Patient-clinician interactions are spaces in which patients present their problems to clinicians and clinicians work with patients to make decisions about care and treatment, but they are also sites for relationship building and managing social interactions. 302,308,321 Therefore, PROMs completion may work in unintended ways to produce unanticipated outcomes, depending on how they fit, or do not fit, with these existing processes. In summary:…”

Section: Summary and Structure Of Our Reviewmentioning

confidence: 99%

Functionality and feedback: a realist synthesis of the collation, interpretation and utilisation of patient-reported outcome measures data to improve patient care

Greenhalgh

Dalkin

Gooding

et al. 2017

Health Serv Deliv Res

177

263

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BackgroundThe feedback of patient-reported outcome measures (PROMs) data is intended to support the care of individual patients and to act as a quality improvement (QI) strategy.ObjectivesTo (1) identify the ideas and assumptions underlying how individual and aggregated PROMs data are intended to improve patient care, and (2) review the evidence to examine the circumstances in which and processes through which PROMs feedback improves patient care.DesignTwo separate but related realist syntheses: (1) feedback of aggregate PROMs and performance data to improve patient care, and (2) feedback of individual PROMs data to improve patient care.InterventionsAggregate – feedback and public reporting of PROMs, patient experience data and performance data to hospital providers and primary care organisations. Individual – feedback of PROMs in oncology, palliative care and the care of people with mental health problems in primary and secondary care settings.Main outcome measuresAggregate – providers’ responses, attitudes and experiences of using PROMs and performance data to improve patient care. Individual – providers’ and patients’ experiences of using PROMs data to raise issues with clinicians, change clinicians’ communication practices, change patient management and improve patient well-being.Data sourcesSearches of electronic databases and forwards and backwards citation tracking.Review methodsRealist synthesis to identify, test and refine programme theories about when, how and why PROMs feedback leads to improvements in patient care.ResultsProviders were more likely to take steps to improve patient care in response to the feedback and public reporting of aggregate PROMs and performance data if they perceived that these data were credible, were aimed at improving patient care, and were timely and provided a clear indication of the source of the problem. However, implementing substantial and sustainable improvement to patient care required system-wide approaches. In the care of individual patients, PROMs function more as a tool to support patients in raising issues with clinicians than they do in substantially changing clinicians’ communication practices with patients. Patients valued both standardised and individualised PROMs as a tool to raise issues, but thought is required as to which patients may benefit and which may not. In settings such as palliative care and psychotherapy, clinicians viewed individualised PROMs as useful to build rapport and support the therapeutic process. PROMs feedback did not substantially shift clinicians’ communication practices or focus discussion on psychosocial issues; this required a shift in clinicians’ perceptions of their remit.Strengths and limitationsThere was a paucity of research examining the feedback of aggregate PROMs data to providers, and we drew on evidence from interventions with similar programme theories (other forms of performance data) to test our theories.ConclusionsPROMs data act as ‘tin openers’ rather than ‘dials’. Providers need more support and guidance on how to collect their own internal data, how to rule out alternative explanations for their outlier status and how to explore the possible causes of their outlier status. There is also tension between PROMs as a QI strategy versus their use in the care of individual patients; PROMs that clinicians find useful in assessing patients, such as individualised measures, are not useful as indicators of service quality.Future workFuture research should (1) explore how differently performing providers have responded to aggregate PROMs feedback, and how organisations have collected PROMs data both for individual patient care and to improve service quality; and (2) explore whether or not and how incorporating PROMs into patients’ electronic records allows multiple different clinicians to receive PROMs feedback, discuss it with patients and act on the data to improve patient care.Study registrationThis study is registered as PROSPERO CRD42013005938.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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Section: Summary and Structure Of Our Reviewmentioning

confidence: 99%

Functionality and feedback: a realist synthesis of the collation, interpretation and utilisation of patient-reported outcome measures data to improve patient care

Greenhalgh

Dalkin

Gooding

et al. 2017

Health Serv Deliv Res

177

263

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“…In turn, by diagnosing the patient's problem and suggesting a treatment doctors respond to the initial request, i.e. grant the service asked for (Ruusuvuori 2000: 84;Heritage and Maynard 2006).However, there is variation in how patients make their initial requests. In addition to the description of symptoms, problem presentations often include affective or moral accounts of the patient's agency as well as the patient's own explanations of illnesses (Ruusuvuori 2000;ten Have 2001;Stivers 2002;Roberts et al 2004).…”

mentioning

confidence: 99%

Patient Involvement in Problem Presentation and Diagnosis Delivery in Primary Care

Ijäs-Kallio¹,

Ruusuvuori²,

Peräkylä³

2011

Communication & Medicine

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This article reports a conversation analytic study of primary care physicians' orientations to different types of patients ' problem presentation IntroductionPatient involvement and participation in medical consultations are strongly encouraged in current healthcare policies (Barry et al. 2001;Thompson 2007). However, in actual face-to-face encounters it is difficult to grasp how patients actually participate and are able to share their views with their doctors (Stevenson et al. 2000; Bissel et al. 2004;Collins et al. 2007). The present article shows how patient participation is realized in the details of talk-in-interaction between doctors and patients. We show how patients' views of their conditions are put forward at the initial phase of the encounter and how these views are oriented to by doctors in ways that shape the communication in the consultation.Medical consultation follows a trajectory of activities. This was first described by Byrne andLong (1984 [1976]) who discerned doctors' behaviours in six phases of consultation: 1. relating to the patient; 2. discovering the reason for the patient's attendance; 3. conducting a verbal and/or physical examination; 4. consideration of the patient's condition; 5. detailing treatment or further investigation; and 6. terminating the visit (Byrne andLong 1984 [1976]: 21-29). Later on, interaction studies have shown that this overall structure informs both doctors' and patients' actions in the visit (Robinson 2003;Heritage and Maynard 2006). It has also been shown that the overall structure of the medical consultation resembles that of a service encounter. By presenting their problem to the doctor, patients make a request for service, questioning the medical expert about their medical concern and its treatment. In turn, by diagnosing the patient's problem and suggesting a treatment doctors respond to the initial request, i.e. grant the service asked for (Ruusuvuori 2000: 84;Heritage and Maynard 2006).However, there is variation in how patients make their initial requests. In addition to the description of symptoms, problem presentations often include affective or moral accounts of the patient's agency as well as the patient's own explanations of illnesses (Ruusuvuori 2000;ten Have 2001;Stivers 2002;Roberts et al. 2004). Accordingly, there is variation Stivers (2002) found that by presenting 'symptoms only' , parents were perceived by doctors as expecting an evaluation of their child. In turn, by presenting candidate diagnoses parents were perceived by doctors as seeking confirmation of the proposed diagnosis and, importantly, treatment for it. In Stivers' (2002) research one important finding was that the doctors' perceptions of their patients' expectations were not always correct. A more focal observation in this article is that: (a) patients are perceived by doctors to have specific aims or views with regard to the outcome of the consultation and that these views are embedded in their initial problem presentation; and (b) doctors take these views into acco...

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“…Following to the RIAS manual [14] the coding was performed directly from the videotapes using the RIAS computer-entry software. Roter Interaction analyse system is one of the most widely used methods to quantitatively explore verbal interactions within different health care settings [15][16][17]. A complete list of RIAS versions used in different health care settings and countries is available at http://www.riasworks.com/resources_a.html [18].…”

Section: Data Analysesmentioning

confidence: 99%

Health dialogues between pupils and school nurses: A description of the verbal interaction

Golsäter¹,

Lingfors²,

Sidenvall³

et al. 2012

Patient Education and Counseling

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Objective:The purpose of this study was to explore and describe the content and the verbal interaction in health dialogues between pupils and school nurses.Method: Twenty-four health dialogues were recorded using a video camera and the conversations were analysed using the paediatric version of the Roter Interaction analysis system.Results:The results showed that the age appropriate topics suggested by national recommendations were brought up in most of the health dialogues. The nurses were the ones who talked most, in terms of utterances. The pupils most frequently gave information about their lifestyle and agreed with the nurses' statements. The nurses summarized and checked that they had understood the pupils, asked closed-ended questions about lifestyle and gave information about lifestyle. Strategies aimed to make the pupil more active and participatory in the dialogues were the most widely used verbal interaction approaches by the nurses. Conclusion:The nurses' use of verbal interaction approaches to promote pupils' activity and participation, trying to build a partnership in the dialogue, could indicate an attempt to build patient-centred health dialogues.Clinical implications: The nurses' great use of questions and being the ones leading the dialogues in terms of utterances point at the necessity for a nurses to have an openness to the pupils own narratives and an attentiveness to what he or she wants to talk about.

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Introduction: Analyzing interaction between doctors and patients in primary care encounters

Cited by 135 publications

References 0 publications

Functionality and feedback: a realist synthesis of the collation, interpretation and utilisation of patient-reported outcome measures data to improve patient care

Functionality and feedback: a realist synthesis of the collation, interpretation and utilisation of patient-reported outcome measures data to improve patient care

Patient Involvement in Problem Presentation and Diagnosis Delivery in Primary Care

Health dialogues between pupils and school nurses: A description of the verbal interaction

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