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Patient and practitioner diagnosis and style - Coggle Diagram
Patient and practitioner diagnosis and style
Practitioner styles (Byrne and Long)
Sample
2500 medical tape recordings in different countries
Six phases of consultation
Establishes a relationship with the patient
Attempts to or actually discover the reason for the patients problems
Conducts a verbal or physical examination
The doctor/patient considers the condition
The doctor may then detail further treatment or further investigation
End of consultation
Procedure
They investigated 7 different prescribing styles that ranged from extremely doctor centered to extremely patient centered
Style 4 - The doctor presents a tentative decision that could change
Style 5 - The doctor presents the problems and makes the decisions
Style 3 - The doctor sells his decision to the patient
Style 6 - The doctor defines the limits and requests the patient to make a decision
Style 2 - The doctor makes a decision then announces it
Style 7 - The doctor permits the patient to make his own decision
Style 1 - The doctor makes the decision about the patient and then instructs the patient to seek some service
Conclusion
Doctors are the product and prisoner of their own medical education
Patients preferred the patient centered approach
Practitioner styles
Doctor centered
Asks closed questions that generally require brief yes/no answers
Takes a controlling role and ignores patients attempts to discuss any problems they may face
Impersonal atmosphere
Use medical jargon
Patient is passive during the consultation
Patient centered
Ask open ended question - 'Can you describe the situation when the pain occurs?'
Avoid medical jargon
Allow the patient to participate in some of the decision making (less controlling)
Personal atmosphere
Patient is active during the consultation
Evaluation
Strength
Large sample size, high generalisability
Weakness
Interpretation of qualitative data could be subjective, less reliability
Cultural bias in westernised countries
Practitioner Styles (Savage and Armstrong)
They investigated the effect of directing and sharing consultation by general practitioner on the satisfaction of patients.
Sample
359 patients
Aged 16 to 75
Procedure
Each participant gave their consent to have their consultation recorded
After the consultation, the patients were asked to fill in a questionnaire about the quality of the communication in the consultation and any thoughts they had. One immediately and one a week later
Results
High levels of satisfaction found in both conditions
Higher levels of satisfaction found in directing group they more people reported 'satisfaction with the explanation of the doctor'
Evaluation
Strength
Reliable procedure followed - doctors followed prompts for the right approach in the same way - high reliability
Weakness
Self-report - social desirability because the patients may have changed their answers in order to please the doctors
Disclosure of information (Robinson and West)