Communicating to Manage Health and Illness

Dale E Brashers, Daena Goldsmith

• Publisher: Routledge
• Year: 2009
• Print ISBN:
  9780805844283
• eBook ISBN:
  9781135628192
• Topic: Medicine
• Subtopic: Communication Studies

Communicating to Manage Health and Illness is a valuable resource for those in the field of health and interpersonal communication, public health, medicine, and related health disciplines. This scholarly edited volume advances the theoretical bases of health communication in two key areas: 1) communication, identity, and relationships; and 2) health care provider patient interaction. Chapters aim to underscore the theory that communication processes are a link between personal, social, cultural, and institutional factors and various facets of health and illness. Contributors to the work are respected scholars from the fields of communication, public health, medicine nursing, psychology, and other areas, and focus on ways in which patient identity is communicated in health-related interactions. This book serves as an excellent reference tool and is a substantial addition to health communication literature.

Chapter 1
Physician-Patient Communication

Psychosocial Care, Emotional Well-Being, and Health Outcomes

Kelly B. Haskard, Summer L. Williams, and M. Robin DiMatteo

Effective physician-patient communication, including awareness of, and engagement with, patients’ psychosocial needs, emotional well-being, and mental health challenges, is essential to physician-patient concordance and to outcomes including patient satisfaction, adherence, and treatment response. Although patient satisfaction is the most frequently studied outcome of communication (Ong, de Haes, Hoos, & Lammes, 1995), adherence and health care outcomes have also been related to physicians’ interpersonal contact expressed through warmth, caring, and listening to the patients’ concerns (Korsch, Gozzi, & Francis, 1968). Such interpersonal elements as affiliativeness (in contrast to dominance, for example) promote patient satisfaction with the medical visit (Buller & Buller, 1987). Partnership and social support from health professionals, as well as from friends and family, are essential to patients’ adherence to recommended treatments (DiMatteo, 2004a; DiMatteo, Reiter, & Gambone, 1994). Research efforts increasingly are being directed toward understanding the role of the therapeutic relationship in fostering physician awareness and patient disclosure of the emotional challenges of illness (Meredith, Orlando, Humphrey, Camp, & Sherbourne, 2001). Appreciating the role of mental health issues, particularly depression and anxiety, in primary care is an essential, though challenging, aspect of everyday medical practice (Wells & Sherbourne, 1999).

The purpose of this chapter is to examine the dimensions of health care interaction that influence physician-patient communication. It is argued that primary care practice inherently requires both awareness and management of psychosocial, emotional, and often mental health challenges in the care of patients. This chapter will address the role of communication in meeting these challenges and improving health care outcomes, and will examine whether and how health professionals’ skills can be improved to achieve effective communication.

The concepts and themes of this chapter will be illustrated with a composite patient vignette, and the most recent evidence will be presented from research on physician-patient communication and the value of care for patients’ psychosocial needs, emotional well-being, and mental health in the primary care setting.

Effective Communication: A Key to Patient-Centered Care

Grace is 25 years old and has Type 1 diabetes. She recently graduated from college and is embarking on a career in public relations with a wellknown New York firm. Her job is stressful with little control, and she usually works more than 60 hours a week. Grace is emotionally close to her family in California, but is not able to see them often. For the first time in her life, Grace is living at such a fast pace that she is failing to make her diabetes, and her overall health, top priorities. After many years of continuous care with the same physician, Grace must see a new doctor in New York. At her first visit, Grace experiences Dr. Carter as businesslike, somewhat cold and remote, and disinterested in discussing anything beyond the technical management of her diabetes.

Communication in the Physician-Patient Relationship

The extensive research literature on physician-patient communication has examined both verbal and nonverbal behavior in the therapeutic dyad. Although somewhat greater attention has been focused on verbal communication (Roter & Hall, 1992), nonverbal behavior has been shown to be essential to the interpersonal context of medical care (Hall, Harrigan, & Rosenthal, 1995). Medical interaction involves two communicative functions—instrumental (task-oriented) exchange and relational (or socioemotional) communication. Task-oriented exchange such as the focus of Dr. Carter in his care of Grace in the vignette above, is primarily verbal, and consists of information-seeking, information-giving, and information-verifying (Cegala, 1997). Such communication usually emphasizes the discussion of biomedical topics (Roter et al., 1997).

Relational communication, on the other hand, is more likely to occur in the context of nonverbal messages, although it also involves verbal communication concerning psychosocial topics. Relational communication includes both verbal and nonverbal expressions of empathy and concern through explicit discussion of emotional experience as well as eye contact, voice tone, facial expressions, and body language and orientation (Ambady & Rosenthal, 1992; DePaulo & Friedman, 1998; Waitzkin, 1984). Nonverbal behaviors play a particularly important role in the development of physician-patient rapport and patient satisfaction (Hall, Roter, & Katz, 1988). Patients tend to be more satisfied with physicians who are better at decoding and encoding nonverbal behavior, particularly those who are more sensitive to patients’ body movement cues of emotion (DiMatteo, Taranta, Friedman, & Prince, 1980).

Socioemotional and Technical Communication

Socioemotional communication, also known as the “art of medicine,” “bedside manner,” humanism, and relational communication began to receive increased attention several decades ago when research evidence suggested that patients were as concerned with the interpersonal aspects of their care as they were with their physicians’ technical competence and expertise (DiMatteo, Friedman, & Taranta, 1979; Friedman, Prince, Riggio, & DiMatteo, 1980). Physicians’ affective and empathic communication is especially important in the opening and history-taking portion of the medical visit when agendas are being set that ultimately affect patients’ health care outcomes (Haidet & Paterniti, 2003; Roter, 2000). Examples of relational and socioemotional communication include such behaviors as asking open-ended questions about the patient’s history and current medical and psychological condition, allowing the patient to speak freely, and affirming the patient’s emotional experience and concerns. Research has shown that when their physicians’ verbal responses indicate disinterest or avoidance (as we see in the behavior of Dr. Carter toward Grace, below), patients limit their disclosure of and willingness to discuss both biomedical and emotional issues that are relevant to their care (Wissow et al., 2002). It is not a surprise, then, that physicians’ socioemotional (interpersonal) behaviors are highly correlated with the technical quality of care that they deliver (DiMatteo & DiNicola, 1981).

The Achievement of Effective Physician-Patient Communication

Grace is dissatisfied with Dr. Carter’s care, but she does not have time to find another doctor who practices in her health insurance panel. Grace’s visits to Dr. Carter often feel like a power struggle. She feels that he is condescending, critical, and insensitive about her management of her diabetes. His tone of voice is passive and disinterested, and he makes little eye contact with her. He interrupts her frequently when she is talking, and he does not seem to listen to what she is saying. When she tries to talk about the stress of her work and her personal life, and even her health habits, he changes the subject to strictly biomedical topics.

Physician-patient communication, both verbal and nonverbal behavior, has been studied in relation to a variety of outcomes. For example, physician voice tone and its interaction with verbal content predict patient satisfaction with care (Hall, Roter, & Rand, 1981). Negative voice tone combined with more positive speech tends to elicit the highest level of satisfaction from patients, perhaps because patients perceive anxious physician voices as demonstrating caring and concern. When physicians were more anxious and angry in their speech, their patients were found to have better compliance with appointment follow-up (Hall, Roter, & Rand, 1981), and alcoholic patients were more adherent to treatment recommendations when their physicians’ voice tones conveyed greater worry and anxiety (Milmoe, Rosenthal, Blane, Chafetz, & Wolf, 1967). In research on verbal behavior, some of the most consistent impediments to effective health outcomes involve physicians’ underestimation of their patients’ level of understanding medicine and their continued use of medical jargon while withholding satisfactory conceptual explanations that would help patients help themselves (DiMatteo & Hays, 1980).

There are numerous reasons why effective communication may be difficult for physicians to implement. Providers may be more concerned with the technical, biomedical aspects of care, too pressed for time to consider psychosocial issues, and unconvinced of the value of effective communication despite its link to better health outcomes (Kreps & Kunimoto, 1994). Of course, reciprocity in physician-patient communication can influence the course of medical treatment and patients’ own verbal and nonverbal cues can influence their physicians’ behavior. For example, in one study the amount of information that physicians gave to patients was strongly influenced by patients’ communicative styles (Street, 1991). The frequency with which patients asked questions strongly affected the degree to which their physicians provided medical information in general and diagnostic and treatment information in particular. Street (1991) found that patients’ verbal responsiveness was influenced by their physicians’ partnership-building behaviors, and the degree to which patients expressed concerns and opinions was positively related to their doctors’ statements of agreement and solicitation of their qu...

Table of contents

• Contents
• Introduction
• Chapter 1 Physician-Patient Communication
• Chapter 2 Unexamined Discourse
• Chapter 3 Doctor-Patient Communication from an Organizational Perspective
• Chapter 4 Exploring the Institutional Context of Physicians’ Work
• Chapter 5 Culture, Communication, and Somatization in Health Care
• Chapter 6 Bilingual Health Communication
• Chapter 7 Negotiating the Legitimacy of Medical Problems
• Chapter 8 Keeping the Balance and Monitoring the Self-System
• Chapter 9 The HIV Social Identity Model
• Chapter 10 Stories and Silences
• Chapter 11 Understanding the Helper
• Chapter 12 Spirituality Provides Meaning and Social Support for Women Living with HIV
• Chapter 13 Multiple Discourses in the Management of Health and Illness
• Index