Analyze communication between patient and general practitioner

[Edgard Eeckman]

Hi

For my PhD I want to analyze communication between a patient and his general practitioner. I read many articles in which observation is used as methodology and consults are recorded on tape our video. Nevertheless, this seems a problem to me. Why?

 

1. Informed consent means that as well the doctor as the patient have to be informed about the research subject and the methodology in advance. My subject is communication and the power relationship and just telling them can influence and thus create bias. Recording without the patient knowing its is ethically unacceptable.

 

2. Being present during the consult seems difficult to me. In the context of a (university) hospital a patient maybe would accept the presence of a third party during his consult, since doctors are often working in the presence of students and residents. Moreover, the relationship between a doctor in a hospital and his patients is different – less personal – than between a general practitioner and his patient (doctor and general practitioner very often share a common history). Therefore it seems to me that the presence of an observer would create more bias during a consult of a general practitioner.

 

Again, I know it has been done very often, but I doubt.

 

A possible solution could be to interview patients (of course if they are willing so) immediately after their consult. But than again I am analyzing their view on things instead of having the possiblility of doing my own analysis.

 

I foresee a mixed approach with expert interviews, one-to-one interviews and focusgroups, but in all these cases I’m analyzing communication intentions and attitudes and we all know that a real difference can exist between these intentions and attitudes and real behaviour. Certainly in my situation where I want to analyze the power belance between both parties.

 

Any comment, reflection and concrete suggestion is very welcome. Many thanks in advance.

 

Kind regards

edgard

 

 

 

 

[Manuel]

HI,

I am not quite familiar much with doing individual research and the corresponding methodologies yet, but I hope I can help a little bit:

what you have talked about the difficulties of the situation are quite real, and generally speaking, any behaviours in front of the camera have certain acting essence, it does change the case.

for what you have described, those difficulties, you can try 1) you take part the patient role and develop a relationship with your own practitioner and record appealing ideas that hit you, in the mean time in oder to acquire more info, you explain this to more people and let them to develop their own relationship and make record, in the end you analyze all the case; 2) you try to make the research more straightforward, i.e. name out each and every items or details you anticipate, and make them simple and specific, collect them from your volunteers, as they are specific, there are less bias.

 

hope your research goes well.

[Joseph Lovett]

With prior consent, of course, you could utilize less obtrustive technologies for recording the aspect of the interaction that interests you — body posture through video-taping or semantics through audio-recording. Regardless, you are correct that there will be something different about that captured interaction. Read the literature about telemedicine and oral histories however. With time and familiarity, the technology will fade into the background of awareness for the practitioner and the patient. Actually, this is a decent research hypothesis in its own right.

 

An alternative, if you are doing a more qualitative research model, would be to “produce” stylized video scenarios and then have persons, doctors and patients comment or score, whatever your preferred method, on the scenario. If you chose such a route, get a grant to do high quality, professionally acted, programming. The more realistic the scenario, the more naturally the dimension of interest to you is portrayed, the higher the quality of the reactions to it. This is even amenable to a focus group and methods and guidelines for doing these successfully abound.

[Berlin Asong]

Epistemologically, all research methods are not bias-free which I think you are aware of. Already you’re considering a mixed research method to reduce bias to a minimum level possible. However, you still could arrive at the same end using a single research approach depending how well you define the research unit or subject which in your case are “communication intentions” and “communication attitudes”.

 

What issues of “communication intentions” and “communication attitudes” are you studying? What issues of  patient-GP communications are you examining? Answers to these questions would help us provide suitable answers to your query.

[Jo Moriarty]

You could also think about conversation analysis – as for example in this study:

 

Barnard RA, Cruice MN, Playford ED (2010) Strategies used in the pursuit of achievability
during goal setting in rehabilitation, Qualitative Health Research, 20, 2, 239–250.

 

This would involve recording the interactions but you would not need to be present.

 

Jo

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