When doctors and patients talk

For most people who come into contact with the NHS, a key element of their experience of care will be their individual consultations with a clinician. Often these interactions are ones that happen in the private space of the consultation room, behind closed doors.

Here we summarise the key findings from a recent Health Foundation research report, When doctors and patients talk: making sense of the consultation, which looks at how important the consultation is in terms of patient experience, and how it can be improved.

Making sense of the consultation

When doctors and patients talk offers a powerful analysis of the current relationship between clinicians and their patients, and of the importance of the consultation. While the nature of these interactions is often fragmented – individual consultations may just be ‘brief touching points on the journey of the patient’s life’ – put together they form a patient’s main experience of the NHS and influence their ability to be involved in their own care.

Martin and Gill, the researchers, point out that the traditional consultation tends to be transactional, often organised around achieving a diagnosis for a discrete problem. This model does not work well in a more modern system, where medical problems are increasingly complex and many patients are living with long-term conditions. The authors argue that the dominant dynamic that exists between patient and clinician during a traditional consultation no longer meets either population healthcare needs or modern expectations of care.

‘...the current dynamic no longer serves either clinicians or patients well, and the degree to which it has shaped the way the NHS operates is to everyone’s disadvantage.’ (p8)

In order to help change this dynamic, it is important to investigate what’s really happening in both doctors’ and patients’ heads during a consultation. The researchers spoke to clinicians and patients in an attempt to understand the different perceptions, and to show how an awareness of this can help to describe a new model for the consultation.

The research uncovered that both doctors and patients can experience different hidden anxieties during the consultation.

Patients' anxieties

• Worried that they may get bad news:
  If I am ill and I don’t go the doctor I might die...but if I do go, she might tell me I’m going to die.
   
• Worried that they are going to get tongue tied and embarrassed:
  Will I be able to say what I need to say and ask what I need to ask?
   
• Worried that they are not sick enough to be there:
  If I go to the doctors and I’m not ill I might be humiliated.

Doctors' anxieties

• Worried that they are going to miss the diagnosis:
  If I miss something vital, the patient might die.
   
• Worried that they will have to handle disappointment and anger:
  There are about 50% of patients that I can do something for and 50% I can’t.
   
• Worried that the system is so complex:
  That they might prescribe something that isn't allowed in the budget or they don't follow the guidelines.

Identifying such anxieties in the consulting room can help to overcome barriers to greater patient involvement in decision making, helping patients to get the right care and treatment.

Improving what happens behind closed doors

The report argues that in order for patients to be better involved in making decisions about their own care, the consultation needs to change. It describes the potential for a more nuanced model of consultation which helps to engage with what patients are really thinking and encourages them to become more involved.

This approach is illustrated in this simple animation, which role plays the traditional format of a patient/clinician consultation and compares it to one where the clinician adapts their questions and comments, empowering the patient to make their own decisions about care.

The Health Foundation view

We believe that people are only able to be active in their care if the right dynamic is created by the way care is provided – both as a whole system and within each individual interaction a patient has with a clinician.

We’re supporting programmes that explore how clinicians and patients can develop the skills needed for better consultations, such as our programmes on shared decision making (MAGIC) and self management support (Co-creating Health). For us, boosting patient confidence while also supporting doctors who are keen to experiment with new ways of working is at the core of how we can improve patient experience across healthcare.

Find out more

Explore case studies, top tips and resources to improve patient experience during consultations through our person-centred care resource centre.