Several studies have also examined the extent to which patients understand the content of the consultation. Boyle (1970) examined patients’ definitions of different illnesses and reported that when given a checklist only 85 per cent correctly defined arthritis, 77 per cent correctly defined jaundice, 52 per cent correctly defined palpitations and 80 per cent correctly defined bronchitis. Boyle further examined patients’ perceptions of the location of organs and found that only 42 per cent correctly located the heart, 20 per cent located the stomach and 49 per cent located the liver. This suggests that understanding of the content of the consultation may well be low. Further studies have examined the understanding of illness in terms of causality and seriousness. Roth (1979) asked patients what they thought peptic ulcers were caused by and found a variety of responses, such as problems with teeth and gums, food, digestive problems or excessive stomach acid. He also asked individuals what they thought caused lung cancer, and found that although the understanding of the causality of lung cancer was high in terms
of smoking behaviour, 50 per cent of individuals thought that lung cancer caused by smoking had a good prognosis. Roth also reported that 30 per cent of patients believed that hypertension could be cured by treatment.
If the doctor gives advice to the patient or suggests that they follow a particular treatment programme and the patient does not understand the causes of their illness, the correct location of the relevant organ or the processes involved in the treatment, then this lack of understanding is likely to affect their compliance with this advice.
F O C U S O N R E S E A R C H 4 . 1 : T E S T I N G A T H E O RY – PAT I E N T S AT I S FA C T I O N
A study to examine the effects of a general practitioner’s consulting style on patient satisfaction (Savage and Armstrong 1990).
This study examined the effect of an expert, directive consulting style and a sharing patient-centred consulting style on patient satisfaction. This paper is interesting for both methodological and theoretical reasons. Methodologically, it uses a random control design in a naturalistic setting. This means that it is possible to compare the effects of the two types of consulting style without the problem of identifying individual differences (these are controlled for by the design) and without the problem of an artificial experi- ment (the study took place in a natural environment). Theoretically, the study examines the prediction that the educational model of doctor–patient communication is problem- atic (i.e. is the expert approach a suitable one?) and examines patient preferences for the method of doctor–patient communication.
Background
A traditional model of doctor–patient communication regards the doctor as an expert who communicates their ‘knowledge’ to the naïve patient. Within this framework, the doctor is regarded as an authority figure who instructs and directs the patient. However, recent research has suggested that the communication process may be improved if a sharing, patient-centred consulting style is adopted. This approach emphasizes an inter- action between the doctor and the patient and suggests this style may result in greater patient commitment to any advice given, potentially higher levels of compliance and greater patient satisfaction. Savage and Armstrong (1990) aimed to examine patients’
responses to receiving either a ‘directive/doctor-centred consulting style’ or a ‘sharing/
patient-centred consulting style’.
Methodology
Subjects The study was undertaken in a group practice in an inner city area of London. Four patients from each surgery for one doctor, over four months were
randomly selected for the study. Patients were selected if they were aged 16–75, did not have a life-threatening condition, if they were not attending for administrative/
preventive reasons, and if the GP involved considered that they would not be upset by the project. Overall, 359 patient were invited to take part in the study and a total of 200 patients completed all assessments and were included in the data analysis.
Design The study involved a randomized controlled design with two conditions: (1) sharing consulting style and (2) directive consulting style. Patients were randomly allo- cated to one condition and received a consultation with the GP involving the appropriate consulting style.
Procedure A set of cards was designed to randomly allocate each patient to a condi- tion. When a patient entered the consulting room they were greeted and asked to describe their problem. When this was completed, the GP turned over a card to determine the appropriate style of consultation. Advice and treatment were then given by the GP in that style. For example, the doctor’s judgment on the consultation could have been either, ‘This is a serious problem/I don’t think this is a serious problem’ (a directive style) or, ‘Why do you think this has happened?’ (a sharing style). For the diagnosis, the doctor could say either, ‘You are suffering from . . .’ (a directive style) or, ‘What do you think is wrong?’ (a sharing style). For the treatment advice the doctor could say either, ‘It is essential that you take this medicine’ (a directive style) or, ‘What were you hoping I would be able to do?’ (a sharing style). Each consultation was recorded and assessed by an independent assessor to check that the consulting style used was in accordance with that selected.
Measures All subjects were asked to complete a questionnaire immediately after each consultation and one week later. This contained questions about the patient’s satisfaction with the consultation in terms of the following factors:
I The doctor’s understanding of the problem. This was measured by items such as
‘I perceived the general practitioner to have a complete understanding’.
I The adequacy of the explanation of the problem. This was measured by items such as
‘I received an excellent explanation’.
I Feeling helped. This was measured by the statements ‘I felt greatly helped’ and ‘I felt much better’.
Results
The results were analysed to evaluate differences in aspects of patient satisfaction between those patients who had received a directive versus a sharing consulting style. In addition, this difference was also examined in relation to patient characteristics (whether the patient had a physical problem, whether they received a prescription, had any tests and were infrequent attenders).
The results showed that although all subjects reported high levels of satisfaction immediately after the consultation in terms of doctor’s understanding, explanation and being helped, this was higher in those subjects who had received a directive style in their consultation. In addition, this difference was also found after one week. When the results were analysed to examine the role of patient characteristics on satisfaction, the results indicated that the directive style produced higher levels of satisfaction in those patients who rarely attended the surgery, had a physical problem, did not receive tests and received a prescription.
Conclusion
The results suggest that a directive consulting style was associated with higher levels of patient satisfaction than a sharing consulting style. This provides support for the educational model of doctor–patient communication with the doctor as the ‘expert’ and the patient as the ‘layperson’. In addition, it suggests that patients in the present study preferred an authority figure who offered a formal diagnosis rather than a sharing doctor who asked for the patient’s views. Therefore, although recent research has criticized the traditional educational model of doctor–patient communication, the results from this study suggest that some patients may prefer this approach.