Limits of 'patient-centredness': valuing contextually specific communication patterns

Tom B. Mole*, Hasna Begum, Nicola Cooper-Moss, Rebecca Wheelhouse, Pieter MacKeith, Tom Sanders, Valerie Wass

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

13 Citations (Scopus)

Abstract

CONTEXT: Globally, doctor-patient communication is becoming synonymous with high-quality health care in the 21st century. However, what is meant by 'good communication' and whether there is consensus internationally remain unclear.

OBJECTIVES: Here, we characterise understandings of 'good communication' in future doctors from medical schools in three contextually contrasting continents. Given locally specific socio-cultural influences, we hypothesised that there would be a lack of global consensus on what constitutes 'good communication'.

METHODS: A standardised two-phase methodology was applied in turn to each of three medical schools in the UK, Egypt and India (n = 107 subjects), respectively, in which students were asked: 'What is good communication?' Phase I involved exploratory focus groups to define preliminary themes (mean number of participants per site: 17). Phase II involved thematic confirmation and expansion in one-to-one semi-structured interviews (mean number of participants per site: 18; mean hours of dialogue captured per site: 55). Findings were triangulated and analysed using grounded theory.

RESULTS: The overarching theme that emerged from medical students was that 'good communication' requires adherence to certain 'rules of communication'. A shared rule that doctors must communicate effectively despite perceived disempowerment emerged across all sites. However, contradictory culturally specific rules about communication were identified in relation to three major domains: family; gender, and emotional expression. Egyptian students perceived emotional aspects of Western doctors' communication strikingly negatively, viewing these doctors as problematically cold and unresponsive.

CONCLUSIONS: Contradictory perceptions of 'good communication' in future doctors are found cross-continentally and may contribute to prevalent cultural misunderstandings in medicine. The lack of global consensus on what defines good communication challenges prescriptively taught Western 'patient-centredness' and questions assumptions about international transferability. Health care professionals must be educated openly about flexible, context-specific communication patterns so that they can avoid cultural incompetence and tailor behaviours in ways that optimise therapeutic outcomes wherever they work around the globe.

Original languageEnglish
Pages (from-to)359-369
Number of pages11
JournalMedical Education
Volume50
Issue number3
Early online date19 Feb 2016
DOIs
Publication statusPublished - Mar 2016

Bibliographical note

Acknowledgements: the authors wish to thank all subjects for their participation in the study. We also wish to thank Sally Jewsbury, Department of Medical Education, University of Manchester, Manchester, UK, Girish Raj, Department of Ear Nose & Throat Surgery, MES Medical College, Kerala, India and El-Said Abdel-Hady, Department of Mansoura Manchester Medical Program, Mansoura University, Mansoura, Egypt, for their help and input into the study.

Funding: TS was supported in the preparation and submission of this paper by the Translating Knowledge into Action Theme of the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care Yorkshire and Humber (NIHR CLAHRC YH) (www.clahrc-yh.nir.ac.uk). The views andopinions expressed are those of the authors, and not necessarily those of the National Health Service (NHS),NIHR or Department of Health

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