What patients want

https://doi.org/10.1016/j.pec.2013.01.005Get rights and content

Abstract

Objective

Although most health care professionals im- or explicitly will assume that they tend to use patient-centered communication strategies, there are reasons to believe that this might not always be a valid assumption. In everyday practice, professionals’ own value system is often the dominant steering guide. This Special Issue aims to bring together ongoing research and reflections about the quality of health care communication from the patients’ own perspective. In short: what do patients want?

Methods

This introduction presents a comprehensive overview of the papers in the special issue of Patient Education and Counseling within a framework that describes the collected papers according to the six functions of medical consultations, taking account of the studies’ applied methodologies: quantitative versus qualitative.

Results

Two functions of the medical consultation are strongly represented in the collected papers on the quality of communication from the patients’ perspective: ‘fostering the relationship’ and ‘information giving’. There is a remarkable difference between the qualiative and quantitative studies, showing that if patients are not limited to prestructured questionnaires but completely free to express themselves, they tend to focus on ‘fostering the relationship’ with an emphasis on personal attention, warmth and empathy.

Conclusions

Patients’ needs and preferences for personalized and humane medical care cannot be overestimated. For the rest, patient diversity is striking, showing the limited usefulness of general communication guidelines for the other five functions of the medical consultation. Researchers should be aware that patients’ views might be different dependent on the applied methodologies.

Introduction

In the shifting scene of patients’ advocacy for centuries, doctors have considered themselves to be the patient's best advocate. Without reflecting too much or too critically on their own role in the medical process, they did their work based on a firm belief that everything they did was always in patient's best interest. This started to change when other disciplines entered the medical arena with their research and teaching activities. In the seventies, sociologists, such as Freidson [1] and Illich [2] unveiled the doctors’ dominance and the power struggle that sometimes takes place in medical consultation rooms. They showed that the interests of doctor and patient may not always coincide. The thousands of citations to their work demonstrate that their then controversial view on the medical profession touched a raw nerve in many people.

Moreover, with the growth of medical knowledge and technology, it became clear that the patient's voice is not automatically heard when doctor use their conventional way of communication, which used to be characterized by structured history taking. As a reaction, medical psychologists became involved in medical education and showed doctors that listening to the patient might be more effective than asking questions in the diagnostic phase [3]. Communication training programmes were developed, initially inspired by Carl Rogers’ concept of unconditional regard, with its emphasis on providing space for the patient, active listening and showing empathy [4]. Patient-centered medicine became the new buzz-word, and was defined by Henbest and Stewart [5] as ‘care in which the doctor responds to the patient in such a way as to allow the patient to express all of his/her reasons for coming, including symptoms, thoughts, feelings and expectations’ (page 28). Note that in these early years the emphasis of communication training was on the first part of the medical consultation, when the agenda still had to be made.

Fairly recently, the scope of most communication skills training has been broadened to incorporate the second part of the medical consultation, where treatment decisions are made and implemented [6]. Parallel to these conceptual developments, the training in communication skills itself became more comprehensive, covering all relevant functions of the medical consultation: (1) fostering the doctor-patient relationship (2) information gathering, (3) information giving, (4) (shared) decision-making, (5) strengthening patient self management and (6) attending to emotions, as presented by de Haes and Bensing [7]. In the meantime, a new generation of professionals stood up as patient advocates. This time the psychologists, nurses and doctors who were involved in teaching communication skills were the ones who claimed to know what patients want. The question remains whether these professionals indeed are better patient advocates than doctors are.

Section snippets

Time to listen to the patients’ voice

The idea for this special issue of Patient Education and Counseling was born during a scientific meeting in Verona, where professionals had a fierce debate on what patient-centered medicine really is. The guest-editors of this special issue were listening to this discussion and asked themselves the logical but unspoken question: where is the patient in this debate? What do patients themselves really want? Professionals claim to be the patients’ advocate, and maybe they are. But why don’t we

Fostering the relationship

Many of the qualitative papers in this special issue have been performed in oncological settings. Unanimously these show the importance of a good doctor–patient relationship. Walczak's et al. [11] paper focuses on the patient perspective when discussing end of life issues. The authors show that talking about acceptance, readiness and adjustment to the inevitable situation may assist patients in helping to plan care, achieve more control and enjoy an optimal quality of life. The patients of this

Information giving

The quantitative studies in this special issue generally cover a number of topics, but – compared to the qualitative studies which tend to focus on ‘the soft side of medicine’ – the attention to the function ‘information giving is striking. Mismatch is a popular topic. Although a large part of the medical consultation is spent on medical information giving, this information does not always fit with patients’ needs. In the paper by Kelly et al. [19], it is reported that 40% of a sample of 141

General guidelines versus patient differentiation

Most communication training programs tend to train general communication skills, based on general guidelines about what constitutes ‘good’ communication. However, several papers in this special issue show that patients are different and need or prefer different communication styles in similar situations. We already referred to Smets’ study on the influence of patient characteristics on their report on trust in the physician: the more anxious patients were the less they fully trusted their

Out of the box: patient centered communication from a different angle

Marketing research is a sector which is specialized in differentiating between various target groups. Closely linked to the private sector, which needs advanced knowledge how to reach different target groups, communication researchers, with their tendency to general guidelines might learn from unusual alliances between academics and marketing specialists. Kravitz et al. [27] paper about a collaborative project involving academics and marketing people demonstrates that such initiatives, although

Conclusions

The papers in this special issue lead to a number of conclusions. Some of these are not new, but are important to mention, because they confirm the existing literature, and thus the validity of views of a number of professionals who claim to be the patients’ advocate. The strong preference and the need for an empathic doctor who is willing to take the time for listening to the patients’ story, and is prepared to seek for tailored solutions is a nice example of a quality indicator which is

Acknowledgement

We would like to thank the authors for their patience. We are very grateful to Catherine Newman (Elsevier) for her continuing great support.

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