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Medical Factors
How patients communicate their illness

At a glance:
This study examined what patients bring to health care communication. Patients contribute more than medical information in their communication with health care professionals. However, how patients communicate their illness is related to how they use the health care system.
Perspectives:
Employee
This study and others like it show that the course and outcome of doctors' consultations are influenced by the patients' communication style. Patients who are more distressed tend to be referred for more investigations and prescribed more intensive treatment. The increased treatments do not necessarily improve the condition, and can even make the situation worse.

The best outcomes are achieved through a partnership between yourself and your treating practitioner. This can be achieved by providing as much information as possible about your condition, letting your treaters know about any worries and concerns, and telling them what is important for you. Taking along a written list of issues and questions can help, and ensure you leave the consultation with key concerns addressed.
Employer
The results of this study are not surprising. Peoples' way of dealing with situations impacts the outcomes. This study looks at the communication style of the patient and notes that the way the patient communicates is associated with differences in the frequency with which they attend the doctor and the amount of time a person has off work.

Encouraging employees to address their concerns with the treating practitioner
treating practitioner
A health professional that treats patients. In return to work this may include doctors, physiotherapists, chiropractors, osteopaths, psychologists, masseurs, etc.
 is important. It is essential that people are able ask questions, express their concerns, and feel confident in their partnership with their treating practitioners. This is best achieved when they are active and confident in their ability to ask questions, discuss options and maintain an interest in the treater's suggestions and recommendations.
Treater
Recognising that a patient's communication style affects the consultation and influences outcomes allows a practitioner to understand the issues and start to address problems.

In the area of work disability
disability
A condition or function that leaves a person unable to do tasks that most other people can do.
 people are often distressed about their condition and worried about the future. Patients who are distressed, or communicate in a negative manner can place the treater under pressure to ‘do something'. Sometimes patients with an intense style have more investigations and treatments. Over investigation and overtreatment can result in even higher levels of distress,
distress
Severe suffering, pain, anxiety or sorrow
 and can result in poorer outcomes.
Insurer
When people are worried or anxious communication may become more strained. This study notes that communication styles can influence the consultation, treatment and outcomes.

Encourage employees to be active in consultation with their treaters, and to make sure they have their questions and concerns addressed. Making a list of concerns or questions can help. Patients can discuss the length of the consultation with the receptionist, and ask for a longer consultation if that is needed to have the questions and concerns addressed.
Original Article, Authors & Publication Details:
L. S. Pettegrew1 and I. D. Turkat2 (1986).

How patients communicate about their illness. Human Communication Research; 12(3):376-394

1University of South Florida
2Universtiy of North Carolina, Greeoro
Background, Study Objectives, How It Was Done:
This review investigated how patients communicate with their doctor about their illness. The study aimed to identify different types of communication behaviour. The authors also wanted to assess whether a patient's communication with their treaters influenced treatment outcomes.

The authors examined other studies on this topic and presented a summary of the information from them. They then presented the findings of the two studies they had done.

Traditionally, doctor-patient communication has been viewed as a way for the doctor to gather information about the patient in order to begin treatment. However, patient communication with the doctor can be influenced by what is said and by how it is said. Both can have strong influences on the consultation.

The research questions asked in this study were:

1. How are the ways patients communicate, behave in a consultation, and respond to advised treatment related to each other?

2. Can recurring types of patient behaviour be identified?

3. Are patients' own reports of their communication with health care providers reliable?

Patients who were suffering from low back pain and seeking help from a doctor were included in the study. The study participants attended a university low back pain clinic in the United States.

Three areas were investigated:

1) Communication style, by a questionnaire that rates the level, such as dominant, open, attentive, etc

2) Illness behaviours, rated through a questionnaire asking more general questions about patients' behaviour in response to their illness, at work and socially. High “work illness behaviour” means the patient is likely to avoid work when feeling ill. High “social illness behaviour” means the patient indicates they are feeling ill by social cues, such as frequently bringing up their illness in conversation or acting unwell.

3) Patients' use of medical treatment, by asking them to report how much money they had spent on treatment in the year, how many times they had visited a hospital and/or doctor, the number of work days they had missed, how much medication they were taking for their pain and the disability payment they had received.

The studies undertaken by the author included:

Study 1:

All patients at the back pain clinic were sent questionnaires with questions about their communication style, illness behaviours and use of medical treatment.

Study 2:

Over a four month period new patients at the back pain clinic were asked to participate in the study. If the patients gave their consent the initial interview between the patient and the head physical therapist was recorded on video. Patients did not seem to react to being videotaped. Researchers then assessed the patients' communication style and illness behaviour from video footage of their interview with the physical therapist. Patients were also asked to complete questionnaires about their communication style, illness behaviour and use of medical treatment. 7 patients participated in this study.
Study Findings:
The authors' main point is that what is communicated is sometimes less important than how the communication occurs. The method or style of communication can have a powerful influence on the investigations performed or treatment undertaken.

The study findings were reported under the following questions:

1. How are the ways patients communicate about their illness, act, and respond to treatment related?

Patients' communication style and illness behaviour were related:

If patients had high social illness behaviour they were more likely to have an open, dramatic, dominant, contentious, animated and precise communication style.

If patients were more likely to lose time from work they were more likely to be in the high social illness behaviour where they communicated more about their condition verbally and non verbally.

Patients' communication and use of medical treatment were also related:

Patients who were active in their communication style (not dramatic, dominant, attentive, contentious and high social illness behaviour) paid the most frequent visits to their physician.

Patients' communication style correlated with days lost from work:

Patients who were animated, attentive and not open in their communication style and had high social illness behaviour missed the most days from work.

2. Are patients' own reports of their communication with health care providers reliable?

No major differences were found between the patients responses to the questionnaires and the researchers' assessment of patient communication style and illness behaviour from the videotaped interview. However, minor differences in the reports were noted and these may account for difficulties in communication between doctor and patient. For example, a patient may think they are communicating assertively while a health care provider may think they are being uncooperative or inappropriate.
Conclusions:
This study examined what patient brings to communication in health care. Patients contribute more than medical information in their communication with health care professionals. Differences in the way patients communicate are associated with how they use medical treatment.

Patients self-reports of their communication style were similar to the researchers' assessment of their communication by videotape. Minor differences were noted and the authors these differences may cause issues in the treatment discussions. For example, a patient may think they are communicating assertively while a health care provider may think they are being uncooperative or inappropriate. Teaching patients to communicate more effectively may improve the outcome of their treatment.
References:
No PubMed Abstract available
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