Rapid responses are electronic comments to the editor. They enable our users
to debate issues raised in articles published on bmj.com. A rapid response
is first posted online. If you need the URL (web address) of an individual
response, simply click on the response headline and copy the URL from the
browser window. A proportion of responses will, after editing, be published
online and in the print journal as letters, which are indexed in PubMed.
Rapid responses are not indexed in PubMed and they are not journal articles.
The BMJ reserves the right to remove responses which are being
wilfully misrepresented as published articles or when it is brought to our
attention that a response spreads misinformation.
From March 2022, the word limit for rapid responses will be 600 words not
including references and author details. We will no longer post responses
that exceed this limit.
The word limit for letters selected from posted responses remains 300 words.
EDITOR - I concur with the overall sentiment espoused by Harrison. I
would, however, like the opportunity to add to the discussion by
suggesting that a lot can be learnt from the evidence in the social
science as applied to health literatures, in particular, the sociology of
health and illness literature on doctor-patient relations.
Sociology has
taken the intricacies and nuances of the complex doctor - patient
interaction as its focus for many years. A great deal of the literature
moves beyond deterministic formulations, whereby the doctor tells and the
patient receives. The attribution of agency to the individual patient, not
just to the doctor, is a central feature of such work. Interaction in the
clinical setting is very much framed as a two-way process to be explicated
and understood.
Harrison made one particular point, where she orientated to the often-
manipulative nature of doctor practice by quoting from a colleague' "I can
usually tell it in such a way that the patient chooses what I want".
Examples of this kind of practice have been cogently demonstrated by some
sociological studies and these, among others, could usefully form part of
the integral evidence base for trainees. Not only do such studies offer
analytically and theoretically robust arguments, but also sometimes such
arguments are based on the minutiae of interactions between doctors and
patients. The utility of such studies is grounded in the difference
between assuming or knowing that some doctors present illness and
treatment information in a particular format, so as to ensure their
preferred disposal is achieved, and being able to see examples of how this
selective presentation operates in situ. Further, such close micro
inspection of interaction allows us to understand the role that patients
play.
Debates about these and other related communication issues are undeniably
important, but the outcome of such discussion could be further enhanced if
broader spectra of the research literature were routinely and, while in
medical training, compulsorily explored. A great deal can be learnt from
less obvious sources for the purposes of medical training and beyond.
Geraldine Leydon research fellow in cancer
Cancer and Public Health Unit, London School of Hygiene and Tropical
Medicine, Keppel Street, London WC1E 7HT.
Doctor-patient Communication: embrace research from different paradigms
EDITOR - I concur with the overall sentiment espoused by Harrison. I
would, however, like the opportunity to add to the discussion by
suggesting that a lot can be learnt from the evidence in the social
science as applied to health literatures, in particular, the sociology of
health and illness literature on doctor-patient relations.
Sociology has
taken the intricacies and nuances of the complex doctor - patient
interaction as its focus for many years. A great deal of the literature
moves beyond deterministic formulations, whereby the doctor tells and the
patient receives. The attribution of agency to the individual patient, not
just to the doctor, is a central feature of such work. Interaction in the
clinical setting is very much framed as a two-way process to be explicated
and understood.
Harrison made one particular point, where she orientated to the often-
manipulative nature of doctor practice by quoting from a colleague' "I can
usually tell it in such a way that the patient chooses what I want".
Examples of this kind of practice have been cogently demonstrated by some
sociological studies and these, among others, could usefully form part of
the integral evidence base for trainees. Not only do such studies offer
analytically and theoretically robust arguments, but also sometimes such
arguments are based on the minutiae of interactions between doctors and
patients. The utility of such studies is grounded in the difference
between assuming or knowing that some doctors present illness and
treatment information in a particular format, so as to ensure their
preferred disposal is achieved, and being able to see examples of how this
selective presentation operates in situ. Further, such close micro
inspection of interaction allows us to understand the role that patients
play.
Debates about these and other related communication issues are undeniably
important, but the outcome of such discussion could be further enhanced if
broader spectra of the research literature were routinely and, while in
medical training, compulsorily explored. A great deal can be learnt from
less obvious sources for the purposes of medical training and beyond.
Geraldine Leydon
research fellow in cancer
Cancer and Public Health Unit, London School of Hygiene and Tropical
Medicine, Keppel Street, London WC1E 7HT.
g.leydon@lshtm.ac.uk
1. Harrison A. Choice is a gift from the patient to the doctor; not
the other way around. BMJ 2000;
Competing interests: No competing interests