Miscommunication in Doctor–Patient Communication

Abstract

The effectiveness of medical treatment depends on the quality of the patient–clinician relationship. It has been proposed that this depends on the extent to which the patient and clinician build a shared understanding of illness and treatment. Here, we use the tools of conversation analysis (CA) to explore this idea in the context of psychiatric consultations. The CA “repair” framework provides an analysis of the processes people use to deal with problems in speaking, hearing, and understanding. These problems are especially critical in the treatment of psychosis where patients and health care professionals need to communicate about the disputed meaning of hallucinations and delusion. Patients do not feel understood, they are frequently non‐adherent with treatment, and many have poor outcomes. We present an overview of two studies focusing on the role of repair as a mechanism for producing and clarifying meaning in psychiatrist–patient communication and its association with treatment outcomes. The first study shows patient clarification or repair of psychiatrists’ talk is associated with better patient adherence to treatment. The second study shows that training which emphasizes the importance of building an understanding of patients’ psychotic experiences increases psychiatrists’ self‐repair. We propose that psychiatrists are working harder to make their talk understandable and acceptable to the patient by taking the patient's perspective into account. We conclude that these findings provide evidence that repair is an important mechanism for building shared understanding in doctor–patient communication and contributes to better therapeutic relationships and treatment adherence. The conversation analytic account of repair is currently the most sophisticated empirical model for analyzing how people construct shared meaning and understanding. Repair appears to reflect greater commitment to and engagement in communication and improve both the quality and outcomes of communication. Reducing potential miscommunication between psychiatrists and their patients with psychosis is a low‐cost means of enhancing treatment from both the psychiatrist and patient perspective. Given that misunderstanding and miscommunication are particularly problematic in psychosis, this is critical for improving the longer term outcomes of treatment for these patients who often have poor relationships with psychiatrists and health care services more widely.

“It means so much for me, to have a choice.” First person perspectives on medication free treatment in mental health care: a qualitative interview study

“…Others felt they coped well, and were satisfied with a life with lower dosages or without AP medication. These findings show how increased psychosocial intervention options support personal recovery processes like increased self-agency and motivation, which is in line with findings from other studies (54,55). However, it is important to take into consideration the possibility of risk regarding both the discontinuation process, and potential selfstigma in the use of coping strategies.…”

Editors' Introduction: Miscommunication

“…There are several points of contact between the CA analysis of repair and cognitive science. The fact that repair sequences are both incremental and jointly managed highlights the fundamentally interactive nature of these processes (see Byun, De Vos, Bradford, U., & Levinson, ; McCabe & Healey, ; Purver et al., ). This creates particular difficulties for sentential approaches to the formal semantics of dialog and alternative approaches, inspired by a consideration of patterns of misunderstanding, are also explored in Ginzburg and Kolliakou () and Larsson ().…”

“…In adult interactions, Brennan and Schober () showed that self‐repairs in which people revise what they are saying mid‐turn, often termed “disfluencies” in linguistics, can demonstrably add to the intelligibility of speaker's turns for their addressees. McCabe and Healey () provide further evidence for the beneficial effect of the use of self‐repairs by mental health professionals on the quality of clinical interactions. In addition, there is experimental evidence that selectively interfering with specific repair mechanisms can speed up or slow down semantic coordination in dialog (see e.g., Healey, ; Healey, Mills, Eshghi, & Howes, ).…”

“…At a minimum, cognitive science needs a much richer conception of the mechanisms people use to detect and deal with miscommunication. The preceding discussion and the collection of papers in this volume suggest this is achievable and that the mixed methods and disciplines of the cognitive sciences can make a productive contribution with potentially important practical applications (see e.g., McCabe & Healey, ; Schober, Suessbrick, & Conrad, ).…”

Family physicians’ problems with patients and own limitations – a qualitative study

“…Research data suggest that non--specific effects explain a considerable amount of the variation in patient outcomes in clinical trials. non-specific effects account for almost 60% of the variance in outcomes across clinical trials [1], indicating that non-specific treatment effects would be more important than specific effects [2] and that the effectiveness of medical procedures also depends on the quality of the physician−patient relationship [3]. essential elements of the physician−patient relationship include verbal and non-verbal communication, effective questioning and transmission of information, expression of empathy and concern, partnership and participatory decision-making [4,5].…”