Exploring information-exchange in consultation: the patients' view of performance and outcomes

Many prescriptions for the 'ideal' consultation highlight the need for discussion, information and explanation as adjuncts to the task of diagnosis and treatment. While there is evidence for the importance of these activities in terms of patient satisfaction, there has been no empirical test of their specific performance in practice, nor of an association between these activities and a range of other outcomes. The present study explores these issues in the context of Frederikson's information-exchange model of medical consultation, using the concept of information-exchange tasks as process variables. Results show that the information-exchange tasks are important to patients, and doctor performance on the tasks provides a good predictor of satisfaction. In addition, it is shown that the immediate outcome measures of patient understanding, the developing doctor-patient relationship, the patient's view of the appropriateness of treatment, and the perceptions of the doctor's response are each related to a particular sub-set of information-exchange activities. It is concluded that attending to the concepts, perceptions and views of the patient offers a more effective strategy for consultation management than a focus on providing vast amounts of standardized information.