Interactional forms of informing, counselling and educating patients

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  • S44 Workshops /Symposia / Patient Education and Counseling 34 (1998) S43 S55

    patients who acted scenarios derived from the workshop Stewart will present the empirical evidence that supportsthe practice of patient-centred medicine. Dr. Stewartsagenda items, role-play in which participants played theirpresentation will include an examination of both quan-own difficult patients in small groups of four or five,titative and qualitative studies that indicate a strongdiscussion of case scenarios of difficult problems andrelationship between patient-centred care and patientfacilitator-led discussions groups. Topics selected assatisfaction, patient outcomes, and doctor satisfaction.being of strong interest to participants included deal-The evidence provided by Dr. Stewart will serve as aing with angry patients (73%), breaking bad newscompelling reason to further our endeavours in the(67%) and discussing patients wishes for resuscitationpractice, teaching and research of the patient-centred(60%). Questionnaire evaluation showed that across allclinical method.workshops participants demonstrated good knowledge of

    positive communication behaviors prior to workshopA Description of the Patient-Centred Clinical Methodparticipation but nonetheless were able to demonstrate

    statistically significant increases in self-confidence re-Judith Belle Brown, Ph.D.Dr. Judith Belle Brown, whogarding the successful use of these communications inhas been active in disseminating the patient-centredclinical practice. Level of satisfaction with the workshopclinical method at the undergraduate, post-graduate andwere high although participants made a number of usefulfaculty levels, will describe the six interactive com-suggestions to improve content and format.ponents of the patient-centred clinical method. The 6components include: (1) exploring both the disease and2 symposium the illness experience; (2) understanding the whole

    PATIENT-CENTRED MEDICINE: TRANSFORM- person; (3) finding common ground; (4) incorporatingING THE CLINICAL METHOD prevention and health promotion; (5) enhancing the

    patient-doctor relationship; and (6) being realistic. Dr.Dr. Judith Belle Brown. Thames Valley Family PracticeBrowns presentation will include case examples and aResearch Unit. 100 Collip Circle, Suite 245, U.W.O.videotape demonstration of the patient-centred clinicalResearch Park, London, Ontario, Canada N6G 4X8method.

    This symposium will describe the Patient-Centred Clini-Innovations in Teaching the Patient-Centred Clinicalcal Method, a revised model for family medicine prac-Methodtice. This method integrates the conventional biomedical

    approach with an under- standing of the patients uniqueRonald Epstein, M.D.experience of illness and contributing contextual factors

    (ie. family and community).Dr. Ronald Epstein has extensive experience in teachingThe primary goal of the symposium is to providethe Patient-Centred Clinical Method at all levels ofparticipants with a thorough and detailed overview of theeducation. Teaching the patient-centred method requiresPatient-Centred Clinical Method and will include appli-specific strategies and innovative techniques as we movecations to clinical practice and innovative teachingfrom the traditional forms of medical education. Whilestrategies. This symposium includes four presentations.many of the teaching strategies examined will not be newto the participants, the specific application of the Patient-The History of the Patient-Centred Clinical MethodCentred Clinical Method will present new challenges and

    Thomas Freeman, M.D. introduce innovative applications to the participantsteaching repertoire. Dr. Epstein will examine the teaching

    Dr. Thomas Freeman, a clinician, educator, researcher inchallenges relevant to undergraduate, post-graduate, fa-

    family medicine for over 20 years, will trace the histori-culty development and continuing medical education.

    cal roots of patient-centred medicine. In his presentationDr. Freeman will describe the contributions of numerous 3 symposiumwriters and theorists to the evolution of the patient-

    INTERACTIONAL FORMS OF INFORMING,centred clinical method. Dr. Freeman will highlight the

    COUNSELLING AND EDUCATING PATIENTSneed and moral imperative for the patient-centred modelof care in the current practice climate. 1 2 1Hanneke Houtkoop-Steenstra , Tony Hak , University of

    Utrecht, Trans 10, 3512 JK Utrecht, The NetherlandsThe Evidence Supporting the Patient-Centred Clinical2Department of primary Care, University of Liverpool,MethodWhelan Building, Brownlow Hill, Liverpool L69 3GB,

    Moira Stewart, Ph.D. UK

    With over 20 years of experience in researching com- Talk by providers of health care to patients can havemunication between patients and doctors, Dr. Moira many very different functions. It can be the delivery of a

  • Workshops /Symposia / Patient Education and Counseling 34 (1998) S43 S55 S45

    diagnosis, or of a proposed treatment. It can be general the institutional nature of the interview and the sequentialadvice (e.g., about lifestyle or diet) or the provision of effects of talk in action.general medical or biological knowledge that is necessary

    Counselling in a health promotion environment: di-for the understanding of a specific condition or advicelemmas and solutions(education). It can also be a form of counselling or a

    form of emotional support. Patients can respond in manyDavid Silverman, Department of Sociology, Goldsmithsdifferent ways to providers talk: by showing surprise, orCollegeNew Cross, London SE14 6NW, UKrelief, anxiety, anger, resistance, misunderstanding, or

    understanding. An emerging theme of conversationThe perceived non-directive character of counselling isanalytic studies of communication in health care is thechallenged in settings where health professionals desiredescription of patterns that can be found in theseto pass on particular health promotion messages. On theactivities of delivery of information (by the provider) andbasis of an international study of HIV-test counselling,reception (by the patient). This will be the topic of thetwo solutions to this dilemma are identified:following five presentations.* extended interviews where, largely through the use of

    hypothetical questions, clients are encouraged to iden-Interactional forms of informing, counselling andtify a piece of tacit adviceeducating clients in dietary counselling

    * short information-based sessions where lack of clientuptake is masked by concealing the advice-givingLinda Tapsell, University of Wollongong, Dep. of Bio-character of the enterprise.medical Science, University of Wollongong, NSW, 2522

    The advantages and limitations of both solutions areAustraliadescribed and the practical implications for health profes-sionals are discussed.Introduction. One of the central features of interactions

    between health care workers and clients is the provisionAchieving a patient-centred consultation by givingof professional advice. Reference to assessment protocolsfeedback in the early stages of the consultationfor student dietitians in Australia suggests that this advice

    may occur in the provision of information on the diet- Tony Hak, University of Liverpool, Peter Campion,disease relationship, assessing current dietary intake University of Hullpatterns and negotiating dietary change. In this paper weexamine how these three actions are displayed in inter- Since the publication of the seminal study Doctorsviews involving student dietitians working in an outpati- Talking to Patients (Byrne & Long 1976) the concept ofent clinic of a major regional hospital in New South a patient-centred consultation has been central both toWales, Australia. studies of doctor-patient interaction and to communica-Methods. During the period 1992-1994, sixty two inter- tion skills training. However, there is a considerableviews involving student dietitians and clients were mismatch between research in this field and the applica-audiorecorded with consent. Methods of conversation tion of its findings, e.g. in training. Extant quantitativeanalysis were applied to the data to identify interactional research, which is based on coding of interactionalforms specific to that of dietary counselling involving moves, cannot contribute to training because its data areentry level practitioners. not specific enough to allow precise and detailed advice.Results. Information on the diet-disease relationship In contrast, qualitative interaction analysis can producetended to occur in the early stages of the interview and descriptions of interactional techniques by which doctorslargely took the form of information delivery iden- achieve a patient-centred consultation. The paper pre-tified in other studies of healthcare counselling. Pro- sents a description of an interactional strategy whichviding assessments of dietary intakes and negotiating consists of providing the patient with information andchange were often packaged in a way similar to a clarifications in the early (history taking) part of theperspective display series found in paediatric consulta- consultation, By using this, doctors are able to teachtions. This particular presentation could be interpreted as patients to become competent interpreters of their owna form of client centred practice, albeit limited within experiences and hence experts on their own condition. Itthe constraints of the interview context. will be discussed whether this technique could be taughtConclusion. In the student driven dietary interview, the and of professional advice was readily identified andfound to have a fairly consistent structure. This may Bad News, Good News, and Uncertain News in thereflect constraints such as assessment protocols, a third Primary Care Clinicparty observer and the relative inexperience of thepractitioner. Overall, the interview was judged as having Doug Maynard, Richard Frankel, Department of Sociolo-a rather more educative than counselling flavour. Be that gy, Indiana University, Ballantine Hall 747, Blooming-as it may, the interactional products were seen to reflect ton, IN 47403, USA


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