Doctor-patient-communication in an oncological outpatient department. A linguistic study of communication problems

摘要

Recognising and attending to patients' most relevant issues and main concerns are the basis for patient-oriented work. This qualitative study investigates the ways in which doctors communicate with their patients. The method of study is conversation and discourse analysis. The source of data are audio recordings of 20 introductory medical consultations in an oncological outpatient department in Austria. In a macro-analytical approach the duration of verbal contribution as well as the topics mentioned are analyzed. Results show that 34 of the consultation time is used for activities other than the actual doctor-patient-communication. Furthermore, the share of patients' verbal contribution was found to be half that of the doctor. Much room is given to information about chemotherapy, less is dedicated to topics like the stages of the illness and the hope for recovery. The micro-analytical approach shows that patients keep trying to allude to topics which are especially relevant to them. This happens very subtly and implicitly by means of interactional markings of relevance. These are communicative and interactive methods such as a change in volume or in speech patterns, the use of strong metaphors or hesitation phenomena. Doctors, however, often give insufficient attention to such initiatives from patients and follow their own, often institutionally-related, pre-requisites. Drawing on two examples, this article shows how insufficient attention to patient-relevant issues results in a lower quality of doctor-patient-communication, and lower satisfaction of patients and doctors. Two positive examples show that adequate attention to patient-relevant issues is possible and increases quality of doctor-patient-communication, as well as participants' satisfaction. It is argued that insufficient attention to patient-relevant issues also reduces time efficiency.