Hearing the patient's story: exploring physician-patient communication using narrative case reports

This study employs narrative case reports to explore clinicians' interpretations of patients' words and behaviors. The purpose of this study is to investigate hospitalized patients' perspectives on medical issues and how these differ from their physicians' perspectives.

Residents identified 19 hospitalized patients over a two-year period with whom they had problems communicating. These residents described the reasons they believed the problems existed and then they questioned the patients about their illness experiences, using an open-ended interview style. Interviewers shared interpretations about the interview and patient behavior. Data were recorded in journal form.

Common to each of the cases were misunderstandings between physicians and patients. The primary concerns of the residents (why they thought patients' behaviors were problematic) differed from the corresponding interpreted understandings of the patients' behaviors. Two case reports illustrate these observations.

This study illustrates how narrative case reports can facilitate the recognition of themes in physician-patient communication that refer to the psychological and social realms of sickness. Such an approach can help identify misperceptions between physicians and patients. Clinicians, educators, and researchers can use this approach, respectively, to improve relationships with patients, to enrich student and resident understandings of communication issues, and to develop new forums for sharing qualitative aspects of physician-patient communication.