Do too many cooks spoil the broth? The effect of observers on doctor-patient interaction.

Do too many cooks spoil the broth? The effect of observers on doctor-patient interaction.

by Ahmed Al-Nowfal -
Number of replies: 5

I think discourse analysis is the analysis of different forms of communication and the meaning behind these social interactions, it is looking at what is said and how its said to get a better idea of  meanings and motives.

 

This article discusses the effect of having additional medical personal to a consultation.  The researchers tried to see how the presence of additional medical personnel in the consultation alters doctors’ responses to patients’ questions, their management of patient-initiated topics, and their use of invitations to ask questions. They also compared the different interaction style when the additional was a medical student or a doctor. The study was conducted by firstly consenting the participate in the study and then audio-recording of the consultation, looking for certain criteria (ie number of invitations to ask a question).

 

What is very interesting in this study is to see how doctors and patients conduct themselves differently when other doctors or students are around.

 

1)The study points out that when a student is present, the doctor invited the patient to talk half as frequently compared to having no additional person there. And when another doctor was present 1/5 of the invitations were offered.  This shows that doctors are influenced by their surroundings and less likely to offer patients centred care.  

 

2)The patients were also a lot less likely to initiate a topic when students were there (half the amount) or other medical personal there (1/6 of the amount). This is intriguing as it shows even though the patient consents to the additional personnel they are not comfortable enough to take lead in the consultation or express their agenda.

 

Bristowe K, Patrick PL. Do too many cooks spoil the broth? The effect of observers on doctor-patient interaction. Blackwell Publishing Ltd 2012. MEDICAL EDUCATION 2012; 46: 785–794

 

http://www.ncbi.nlm.nih.gov/pubmed/22803756

In reply to Ahmed Al-Nowfal

Re: Do too many cooks spoil the broth? The effect of observers on doctor-patient interaction.

by Yasin Fatine -

I think a problem with using discourse analysis in this situation is that although it was found that less interaction took place, we cannot deduce that the patient received a lower standard of care. Also the presence of the audio equipment in the one-to-one scenario may have had an effect on the responses the patient gave, and on the doctor's frequency of speech. Questioning participants directly could possibly yield interesting results.

In reply to Yasin Fatine

Re: Do too many cooks spoil the broth? The effect of observers on doctor-patient interaction.

by Deleted user -

That's a good point you've raised, Yasin. (at least, i think so). One has to wonder to what extent does the method of 'discourse analysing' influence the end result of the study.

In reply to Yasin Fatine

Re: Do too many cooks spoil the broth? The effect of observers on doctor-patient interaction.

by Ahmed Al-Nowfal -

i dont think the purpose of the study was to judge 'standard of care' it was to see how the interaction between a doctor and patient are altered with other people present in the room. its a comparison therefore, even though the equipment might be a confounding factor in one or one, in itself, it should decrease the same amount with all the patients alike therefore, you can compare the  the different interactions. You raise a good point in regards to a direct interview with the patient after the consultation, but i dont think you will be assess the same factors (number of question asked, number of topics generated etc), maybe having it as an additional tool will allow you to see how the patient felt?

In reply to Ahmed Al-Nowfal

Re: Do too many cooks spoil the broth? The effect of observers on doctor-patient interaction.

by Sandeep Suryadevara Rao -

Good topic with a good title. I think with or without post-consultation interviews the presence of extra people in the room makes the patient feel more self-conscious and nervous, since they are essentially being 'studied' and can feel scrutinised.

And even if we were looking at standard of care, the way the patient feels during/after the consultation would have to be considered when assessing the 'standard'. Overall, we know that patients want to be listened to, so therefore value having the chance to speak (which they can only do if they feel able to speak!). Patients want to be involved in their care plan.

I acknowledge that some patients would tolerate a trip to the doctor as being something to endure, which is worth it if they are 'cured' afterwards. But for some patients (perhaps moreso where no cure is available) the emotional journey through the hospital is also very important, independent of what they are finally prescribed

In certain cases patient anxiety levels are proportionate to the number of students/observers in the room. But health students can also have a very positive impact on patients well-being: for example, by spending time talking to lonely patients on old-age wards. Perhaps discourse analysis should be carried out to investigate the 1:1 student-patient interaction, since patients may be able to disclose even more symptoms than they would to a doctor, since they are under less pressure

In reply to Sandeep Suryadevara Rao

Re: Do too many cooks spoil the broth? The effect of observers on doctor-patient interaction.

by Deleted user -

think this study was more on the response of the doctor in the presence of  another doctor who can be senior or junior colleague i think this can have some effects on the doctors interaction with the patient for example if the third party are senior colleagues and the doctor in question is new in the practice he will be under a test rather than attending to the patient and on the other hand the interaction will be different if he has student doctor around he will be more in control  of the situation and on the patients  side like sandip has said the anxiety level may either be increased or decreased depending on the patient in question.

I think a discourse analysis study can be done using the same set of doctors and patient under this different conditions to see the effect on both the patient and the doctor