Mole, T.B., Begum, H., Cooper-Moss, N. et al. (4 more authors) (2016) Limits of 'patient-centredness'; valuing contextually specific communication patterns. Medical Education, 50 (3). pp. 359-369. ISSN 1365-2923
Abstract
Context Globally, doctor–patient communication is becoming synonymous with high-quality health care in the 21st century. However, what is meant by ‘good communication’ and whether there is consensus internationally remain unclear.
Objectives Here, we characterise understandings of ‘good communication’ in future doctors from medical schools in three contextually contrasting continents. Given locally specific socio-cultural influences, we hypothesised that there would be a lack of global consensus on what constitutes ‘good communication’.
Methods A standardised two-phase methodology was applied in turn to each of three medical schools in the UK, Egypt and India (n = 107 subjects), respectively, in which students were asked: ‘What is good communication?’ Phase I involved exploratory focus groups to define preliminary themes (mean number of participants per site: 17). Phase II involved thematic confirmation and expansion in one-to-one semi-structured interviews (mean number of participants per site: 18; mean hours of dialogue captured per site: 55). Findings were triangulated and analysed using grounded theory.
Results The overarching theme that emerged from medical students was that ‘good communication’ requires adherence to certain ‘rules of communication’. A shared rule that doctors must communicate effectively despite perceived disempowerment emerged across all sites. However, contradictory culturally specific rules about communication were identified in relation to three major domains: family; gender, and emotional expression. Egyptian students perceived emotional aspects of Western doctors’ communication strikingly negatively, viewing these doctors as problematically cold and unresponsive.
Conclusions Contradictory perceptions of ‘good communication’ in future doctors are found cross-continentally and may contribute to prevalent cultural misunderstandings in medicine. The lack of global consensus on what defines good communication challenges prescriptively taught Western ‘patient-centredness’ and questions assumptions about international transferability. Health care professionals must be educated openly about flexible, context-specific communication patterns so that they can avoid cultural incompetence and tailor behaviours in ways that optimise therapeutic outcomes wherever they work around the globe.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | © 2016 John Wiley & Sons Ltd. This is an author produced version of a paper subsequently published in Medical Education. Uploaded in accordance with the publisher's self-archiving policy. |
Dates: |
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Institution: | The University of Sheffield |
Academic Units: | The University of Sheffield > Faculty of Medicine, Dentistry and Health (Sheffield) > School of Health and Related Research (Sheffield) > ScHARR - Sheffield Centre for Health and Related Research |
Depositing User: | Symplectic Sheffield |
Date Deposited: | 26 Oct 2015 15:00 |
Last Modified: | 11 Apr 2017 08:38 |
Published Version: | http://dx.doi.org/10.1111/medu.12946 |
Status: | Published |
Publisher: | Wiley |
Refereed: | Yes |
Identification Number: | 10.1111/medu.12946 |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:91221 |