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Related Experiment Videos

"Fire away": the opening sequence in general practice consultations.

Joseph Gafaranga1, Nicky Britten

  • 1Department of General Practice and Primary Care, Guy's King's and St Thomas' School of Medicine, King's College London, UK.

Family Practice
|May 10, 2003
PubMed
Summary
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Doctor-patient communication rules impact relationship mutuality. Understanding opening sequences and deviations is key for achieving concordance and shared decision-making in general practice.

Area of Science:

  • Medical Sociology
  • Communication Studies
  • General Practice

Background:

  • Recent models of the doctor-patient relationship emphasize mutuality over paternalism or consumerism.
  • Achieving mutuality in doctor-patient interactions requires practical strategies.
  • Limited research exists on the specific mechanisms for fostering mutuality.

Purpose of the Study:

  • To identify rules governing the initial phase of general practice consultations.
  • To analyze how adherence to or deviation from these rules influences patient-GP mutuality.

Main Methods:

  • Qualitative study involving 62 patients and 20 general practitioners (GPs) in England.
  • Audio-recorded consultations, pre- and post-consultation patient interviews, and post-consultation doctor interviews.

Related Experiment Videos

  • Conversation Analysis used to analyze participants' speech and understandings.

    • Main Results:

    • A rule for selecting opening questions ("How are you?" vs. "What can I do for you?") was identified.
    • Deviations from this rule can be repairable (misunderstandings) or strategic (relationship emphasis).
    • Unrepaired deviations lead to participant misalignment, hindering mutuality.

    Conclusions:

    • Alignment or misalignment occurs early in consultations, before treatment discussions.
    • Misalignment makes achieving concordance and shared decision-making more difficult.
    • Mutuality is a collaborative achievement requiring active patient participation.