The dynamics of doctor-patient conversations:A linguistical analysis

Abstract

INTRODUCTION AND OBJECTIVES: Concerns exist on the communication skills of doctors in medical practice. The aim of this study was to explore the linguistic dynamics of communication between doctors and patients in the Sri Lankan cultural context.METHODS: A qualitative study was conducted in wards of major disciplines in North-Colombo Teaching Hospital. 16 out of 48 audio-recorded patient consultations of intern house officers were subjected to preliminary linguistic analysis of the open vs closed ended questioning, tolerability of silence, time distribution between doctors and patients, use of technical jargon and emotional expressions.RESULTS: The average consultation time was l 7min 40s (Range: 4min, 45s - 30min, 56s) and was distributed between patient 4 min, 57s (Range: 34s - 18mins ,l ls), doctor 2 min (Range: 3ls - 4min, 36s) and other activities like documentation. Therefore, the average time distribution between doctor and the patient during a consultation was 1 :2.5. 74.66% of the doctors' questions were closed-ended. 83% of the time patients provided detailed answers to closed-ended questions. Doctors used repeating and paraphrasing to encourage non-respondents and rarely used technical jargon. Questioning was friendly but the tone of the conversation was hierarchical. However, it enabled developing good rapport with patients. Doctors rarely showed irritation and it was expressed implicitly through hurried questioning and high-toned voice.CONCLUSION: The linguistic dynamics of consultations demonstrated the presence of elements of the Eastern cultural norm of hierarchy. Limited patient-centredness of doctors was not observed negatively by patients. Patients appeared to be more empowered, may be due to the 'narrow power-gap' between junior-doctors and patients.