Learning more about the decision making context is important

General practice p 1246

Communication difficulties between doctors and patients have been looked at by researchers from several disciplines who have tried to explore why these occur. Mishler, for example, has argued that doctors and patients talk to each other with different voices.1 The voice of medicine is characterised by medical terminology, objective descriptions of physical symptoms, and the classification of these within a reductionist biomedical model.1 The voice of patients, on the other hand, is characterised by non-technical discourse about the subjective experience of illness within the context of social relationships and the patient's everyday world. Typically, doctors have more power than patients to structure the nature of the interaction between them. As a consequence, patients may feel that their voice is overridden, silenced, or stripped of personal meaning and social context. To improve communications between doctors and patients we need also to understand the nature of the decision making that is taking place in the consultation.

Two recent papers in the BMJ, one of them published this week (p 1246),focus on the type and frequency of communication misunderstandings experienced by general practitioners and their patients in 20 English general practices.2 …