This chapter explores the essence of the general practitioner (GP)-patient encounter by looking at what is actually being communicated in the consulting room. In terms of conversational input of GP and patient, the average GP-patient encounter appears quite equal. A more detailed analysis shows GPs taking the lead, by giving instructions and asking questions more often, and paying relatively little attention to psychosocial issues. Various societal developments have taken place, which have contributed to a changing role of GPs and their patients. These developments include the epidemiological shift from acute to chronic illnesses; the change from illness-focused to patient-focused communication; the increased accessibility of information and a more equitable doctor-patient relationship. The verbal communication was rated using the Roter Interaction Analysis System. This system distinguishes affect-oriented, task-oriented and process-oriented doctor-patient communication. GP-patient communication is balanced in terms of their respective input.

Although the recovery of patients suffering from low back pain is highly context dependent, patient preferences about treatment options are seldom incorporated into the therapeutic plan. Shared decision-making (SDM) offers a tool to overcome this deficiency. The reinforcement by the general practitioner (GP) of a ‘shared’ chosen therapy might increase patients’ expectations of favourable outcomes and thus contribute to recovery.

Patients? first impressions obtained during early contacts with doctors represent the basis for relationship building processes. Aim of this study was to verify how patients? first impression of doctors? communication approach influences patients? global assessment of doctors? performance. This cross-sectional study was part of a larger, multicenter observational study aiming to assess lay-people?s preferences regarding patient?doctor communication. All participants (N?=?136) were equally distributed over two selected Italian and Dutch recruitment centers as well as for gender and age. In each center, panels of 6?9 persons each watched the same set of eight videotaped Objective Structured Clinical Examination consultations. Participants performed different tasks as to pick up salient communication elements while watching the videos and to rate doctors? global communicative performances on a 10-point Likert scale. We performed a mediation analysis to assess direct and indirect effects of participants? first impression on participants? global assessment. Among the 439 collected first impressions, 284(65%) were positive. When the first impression was positive, the mean value of the global assessment of doctors? performance was significantly higher (M?=?7.4, SD?=?1.5) than when the first impression was negative (M?=?6.0, SD?=?1.6); t(437)?=?9.0 p?<?.001. According to the mediation analysis, this difference was due to a direct (c??=?0.53) and an indirect effect (ab?=?0.86) deriving from the total effect of first impressions on the global assessment of doctors? performances (c?=?1.39). In conclusion, the first impression has a strong impact on positive and negative judgments on doctors? communication approach and may facilitate or inhibit all further interactions.

Despite widespread documentation of racial/ethnic disparities in medical care, population-wide variation in Americans’ experiences with care are not well understood. We examined whether race/ethnicity is associated with information received from physicians regarding treatment recommendations.We conducted a secondary analysis of cross-sectional survey data from a nationally representative sample (N = 1238). We assessed patients’ personal experiences of receiving information about the rationale for treatment recommendations from their physicians.Overall, respondents of minority race/ethnicity received less information from their doctors about the rationale for treatment recommendations. After adjustment for possible confounders, doctors talked less often with patients of ‘other’ race/ethnicity about reasons for treatment recommendations. Both Blacks’ and Hispanics’ doctors less often cited their own experiences, or scientific research as a reason for treatment recommendations.Americans’ experiences with information communicated by physicians regarding treatment rationale varies significantly on some dimensions by race/ethnicity, suggesting that differences in key elements of shared decision making are evident in the care of racial/ethnic minorities.Physicians should evaluate the extent to which their communication with patients varies by patient race/ethnicity, and make efforts to ensure that they share equally with all patients regarding the rationale for treatment recommendations.

Background:Empathy is regarded by patients and general practitioners (GPs) as fundamental in patient-GP communication. Patients do not always experience empathy and GPs encounter circumstances which hamper applying it.Objective:To explore why receiving and offering empathy during the encounter in general practice does not always meet the wishes of both patients and GPs.Method:A qualitative research method, based on focus group interviews with patients and in-depth interviews with GPs, was carried out. Within the research process, iterative data collection and analysis were applied.Results:Both patients and GPs perceive a gap between what they wish for with regard to empathy, and what they actually encounter in general practice. Patients report on circumstances which hamper receiving empathy and GPs on circumstances offering it. Various obstacles were mentioned: (i) circumstances related to practice organization, (ii) circumstances related to patient-GP communication or connectedness, (iii) differences between the patient's and the GP's expectations, (iv) time pressure and its causes and (v) the GP's individual capability to offer empathy.Conclusion:When patients do not receive empathy from their GP or practice staff, they feel frustrated. This causes a gap between their expectations on the one hand and their actual experiences on the other. GPs generally want to incorporate empathy; the GP's private, professional and psychological well-being appears to be an important contributing factor in practicing empathy in daily practice. But they encounter various obstacles to offer this. It is up to GPs to take responsibility for showing practice members the importance of an appropriate empathical behaviour towards patients.

Seventeen relevant papers from six electronic databases were identified and synthesized using seven stages following Noblit and Hare (1988). RESULTSThrough the translation of key themes, an iterative process of an individual's behavior to reach mastering over CRC was identified as a constant key concept within the larger context of symptom experience over the illness trajectory.This process contains (1) balancing, as a reaction first and foremost to situations, for 'making sense' or to 'share'; (2) mastering, to achieve emotional and physical control especially 'with controlling ones' body'; and (3) normalizing as a successful or adequate adaption to new situations particularly 'with reforming life'. OBJECTIVESThe goal of this meta-ethnography was to depict the process of mastery of symptoms related to CRC and its treatment, to develop a better understanding of individuals' symptom experiences.

This chapter shows that despite their preferences, many patients do not have a female general practitioner (GP). Preferences of female GPs are not fulfilled for a one-third of female and two-thirds of male patients. The reason is that the higher number of female medical students has not led to enough practising female GPs yet. Those patients that have a preference for a female GP are morer often female and younger. Furthermore, communication patterns have become more pragmatic. Nowadays, both male and female GPs talk less with their patients, express less empathy and concern, and talk less about biomedical and psychosocial issue than in 1987. Nevertherless, female GPs still talk more with patients than their male colleagues do. Compared with male GPs, they give more information, especially about biomedical issues. They also look more at their patients and are more affective. Communication patterns are not related to the patients gender.(aut .ref.)

Empathie speelt een belangrijke rol in de patiënt-huisartscommunicatie met het oog op persoonsgerichte zorg. Een empathische houding levert de huisarts meer informatie op over de situatie van de patiënt, verbetert de onderlinge relatie en maakt dat patiënten zich meer op hun gemak voelen. In de dagelijkse praktijkvoering is maar weinig ruimte voor zo’n empathische houding, bijvoorbeeld omdat de huisarts moet letten op het juist toepassen van standaarden en protocollen, telkens weer op het computerscherm moet kijken, met tijdsdruk kampt of administratieve zaken moet afhandelen. Persoonsgerichte zorg kan daardoor in de knel komen. Wij hebben een kwalitatief onderzoek gedaan naar de rol van empathie in de communicatie tussen patiënt en huisarts. Huisartsen geven aan dat intervisiegroepen behulpzaam kunnen zijn bij het behouden van empathie in de dagelijkse praktijk. Wanneer zorgverzekeraars het belang van empathie gaan inzien, kunnen zij tijd en aandacht voor de patiënt gaan financieren. Het is zinvol om tijdens de huisartsopleiding veel aandacht te besteden aan een empathische grondhouding, cognitieve verdieping van empathie aan te bieden en gerichter te trainen door reflectie op empathisch gedrag.

Background: To improve early risk-identification in pregnancy, research on prediction models for common pregnancy complications is ongoing. Therefore, it was the aim of this study to explore pregnant women's perceptions, preferences and needs regarding prediction models for first trimester screening for common pregnancy complications, such as preeclampsia, to support future implementation.Method: Ten focus groups (of which five with primiparous and five with multiparous women) were conducted (n = 45). Six focus groups were conducted in urban regions and four in rural regions. All focus group discussions were audio taped and NVIVO was used in order to facilitate the thematic analysis conducted by the researchers.Results: Women in this study had a positive attitude towards first trimester screening for preeclampsia using prediction models. Reassurance when determined as low-risk was a major need for using the test. Self-monitoring, early recognition and intensive monitoring were considered benefits of using prediction models in case of a high-risk. Women acknowledged that high-risk determination could cause (unnecessary) anxiety, but it was expected that personal and professional interventions would level out this anxiety.Conclusion: Women in this study had positive attitudes towards preeclampsia screening. Self-monitoring, together with increased alertness of healthcare professionals, would enable them to take active actions to improve pregnancy outcomes. This attitude enhances the opportunities for prevention, early recognition and treatment of preeclampsia and probably other adverse pregnancy outcomes.

Objective: We conducted a clustered randomised controlled trial to study the effects of shared decision making (SDM) on patient recovery. This study aims to determine whether GPs trained in SDM and reinforcing patients' treatment expectations showed more trained behaviour during their consultations than untrained GPs.Methods: We compared 86 consultations conducted by 23 trained GPs with 89 consultations completed by 19 untrained GPs. The primary outcomes were SDM, as measured by the OPTION scale, and positive reinforcement, as measured by global observation. Secondary outcomes were the level of autonomy in decision making and the duration of the consultation.Results: Intervention consultations scored significantly higher on most elements of the OPTION scale, and on the autonomy scale; however, they were three minutes longer in duration, and the mean OPTION score of the intervention group remained below average.Conclusion: Training GPs resulted in more SDM behaviour and more autonomy for the patient; however, this increase is not attributable to the adoption of a patient perspective. Furthermore, while we aimed to demonstrate that SDM facilitates the reinforcement of patients' positive expectations, the measurement of this behaviour was not reliable.Practice implications: In supporting SDM, professionals should give greater attention to patients' treatment expectations. (C) 2016 Elsevier Ireland Ltd. All rights reserved.

Objective: To assess European patients' preferences regarding seven aspects of doctor-patient communication. Methods: 6049 patients from 31 European countries evaluated 21 doctor and 12 patient behaviours, through a patient-generated questionnaire (PCVq). Multilevel models explored the effects of patient characteristics, contextual and cultural dimensions on preferences. Results: Patients attributed more responsibility to doctors, by giving greater importance to doctor than to patient factors, in particular to Treating the patient as a partner and as a person and Continuity of care. Gender, age, education, the presence of chronic illness and two of Hofstede's cultural dimensions, Individualism and Indulgence, showed differential evaluations among patients. Women gave greater importance to all seven communication aspects, older patients to being prepared for the consultation, lower educated patients to Treating patient as a person and Thoughtful planning. Patients from countries with an indulgent background rated all seven communication aspects of greater importance. A more individualistic orientation was related to lower importance regarding the four doctor's factors and the patient factor Open and Honest. Conclusions: Treating the patient as a person and providing continuity of care emerged as universal values. Practice implications: The findings should represent a landmark for the adaptation of patient-generated communication guidelines and programs in Europe. (C) 2018 Elsevier B.V. All rights reserved.

Objective: To experimentally test the effects of physician's affect-oriented communication and inducing expectations on outcomes in patients with menstrual pain.Methods: Using a 2 X 2 RCT design, four videotaped simulated medical consultations were used, depicting a physician and a patient with menstrual pain. In the videos, two elements of physician's communication were manipulated: (1) affect-oriented communication (positive: warm, emphatic; versus negative: cold, formal), and (2) outcome expectation induction (positive versus uncertain). Participants (293 women with menstrual pain), acting as analogue patients, viewed one of the four videos. Pre-and post video participants' outcomes (anxiety, mood, self-efficacy, outcome expectations, and satisfaction) were assessed.Results: Positive affect-oriented communication reduced anxiety (p < 0.001), negative mood (p = 0.001), and increased satisfaction (p < 0.001) compared to negative affect-oriented communication. Positive expectations increased feelings of self-efficacy (p < 0.001) and outcome expectancies (p < 0.001), compared to uncertain expectations, but did not reduce anxiety. The combination of positive affectoriented communication and a positive expectation reduced anxiety (p = 0.02), increased outcome expectancies (p = 0.01) and satisfaction (p = 0.001).Conclusion: Being empathic and inducing positive expectations have distinct and combined effects, demonstrating that both are needed to influence patients' outcomes for the best.Practice implications: Continued medical training is needed to harness placebo-effects of medical communication into practice. (C) 2017 Elsevier B.V. All rights reserved.

Introduction Placebo effects (true biopsychological effects not attributable to the active ingredients of medical technical interventions) can be attributed to several mechanisms, such as expectancy manipulation and empathy manipulation elicited by a provider’s communication. So far, effects have primarily been shown in laboratory settings. The aim of this study is to determine the separate and combined effects of expectancy manipulation and empathy manipulation during preoperative and postoperative tonsillectomy analgesia care on clinical adult patients’ outcomes. Methods and analysis Using a two-by-two randomised controlled trial, 128 adult tonsillectomy patients will be randomly assigned to one out of four conditions differing in the level of expectancy manipulation (standard vs enhanced) and empathy manipulation (standard vs enhanced). Day care ward nurses are trained to deliver the intervention, while patients are treated via the standard analgesia protocol and hospital routines. The primary outcome, perceived pain, is measured via hospital routine by a Numeric Rating Scale, and additional prehospitalisation, perihospitalisation and posthospitalisation questionnaires are completed (until day 3, ie, 2 days after the operation). The manipulation is checked using audio recordings of nurse–patient interactions. Ethics and dissemination Although communication is manipulated, the manipulations do not cross norms or values of acceptable behaviour. Standard medical care is provided. The ethical committee of the UMC Utrecht and the local OLVG hospital committee approved the study. Results will be published via (inter)national peer-reviewed journals and a lay publication. Trial registration number NTR5994; Pre-results.

BACKGROUND:Current daily general practice has become increasingly technical and somatically oriented (where attention to patients' feelings is decreased) due to an increase in protocol-based guidelines. Priorities in GP-patient communication have shifted from a focus on listening and empathy to task-oriented communication.AIM:To explore what barriers GPs experience when applying empathy in daily practice, and how these barriers are managed.DESIGN AND SETTING:Thirty Dutch GPs with sufficient heterogeneity in sex, age, type of practice, and rural or urban setting were interviewed.METHOD:The consolidated criteria for reporting qualitative research (COREQ) were applied. The verbatim transcripts were then analysed.RESULTS:According to participating GPs, the current emphasis on protocol-driven care can be a significant barrier to genuineness in communication. Other potential barriers mentioned were time pressures and constraints, and dealing with patients displaying 'unruly behaviour' or those with personality disorders. GPs indicated that it can be difficult to balance emotional involvement and professional distance. Longer consulting times, smaller practice populations, and efficient practice organisation were described as practical solutions. In order to focus on a patient-as-person approach, GPs strongly suggested that deviating from guidelines should be possible when necessary as an element of good-quality care. Joining intercollegiate counselling groups was also discussed.CONCLUSION:In addition to practical solutions for barriers to behaving empathically, GPs indicated that they needed more freedom to balance working with protocols and guidelines, as well as a patient-as-person and patient-as-partner approach. This balance is necessary to remain connected with patients and to deliver care that is truly personal.

Objective: There is general consensus that explicit expression of empathy in patient-GP communication is highly valued. Yet, little is known so far about patients' personal experiences with and expectations of empathy. Insight into these experiences and expectations can help to achieve more person-centeredness in GP practice care.Methods: Participants were recruited by a press report in local newspapers. Inclusion criteria: adults, a visit to the GP in the previous year. Exclusion criterion: a formal complaint procedure. Five focus groups were conducted. The discussions were analyzed using constant comparative analysis.Results: In total 28 participants took part in the focus group interviews. Three themes were identified: (1) Personalized care and enablement when empathy is present; (2) Frustrations when empathy is absent; (3) Potential pitfalls of empathy. Participants indicated that empathy helps build a more personal relationship and makes them feel welcome and at ease. Furthermore, empathy makes them feel supported and enabled. A lack of empathy can result in avoiding a visit to the GP.Conclusion: Empathy is perceived as an important attribute of patient-GP communication. Its presence results in feelings of satisfaction, relief and trust. Furthermore, it supports patients, resulting in new coping strategies. A lack of empathy causes feelings of frustration and disappointment and can lead to patients avoiding visiting their GP.Practice implications: More explicit attention should be given to empathy during medical education in general and during vocational GP-training. (C) 2016 Elsevier Ireland Ltd. All rights reserved.

Background Uptake rates for Down syndrome screening in the Netherlands are low compared to other European countries. To investigate the low uptake, we explored women’s reasons for participation and possible influences of national healthcare system characteristics. Dutch prenatal care is characterised by an approach aimed at a low degree of medicalisation, with pregnant women initially considered to be at low risk. Prenatal screening for Down syndrome is offered to all women, with a ‘right not to know’ for women who do not want to be informed on this screening. At the time this study was performed, the test was not reimbursed for women aged 35 and younger. Methods We conducted a qualitative study to explore reasons for participation and possible influences of healthcare system characteristics. Data were collected via ten semi-structured focus groups with women declining or accepting the offer of Down syndrome screening ( n = 46). All focus groups were audio- and videotaped, transcribed verbatim, coded and content analysed. Results Women declining Down syndrome screening did not consider Down syndrome a condition severe enough to justify termination of pregnancy. Young women declining felt supported in their decision by perceived confirmation of their obstetric caregiver and reassured by system characteristics (costs and age restriction). Women accepting Down syndrome screening mainly wanted to be reassured or be prepared to care for a child with Down syndrome. By weighing up the pros and cons of testing, obstetric caregivers supported young women who accepted in the decision-making process. This was helpful, although some felt the need to defend their decision to accept the test offer due to their young age. For some young women accepting testing, costs were considered a disincentive to participate. Conclusions Presentation of prenatal screening affects how the offer is attended to, perceived and utilised. By offering screening with age restriction and additional costs, declining is considered the preferred choice, which might account for low Dutch uptake rates. Autonomous and informed decision-making in Down syndrome screening should be based on the personal interest in knowing the individual risk of having a child with Down syndrome and system characteristics should not influence participation.

•Goede communicatie is belangrijk voor patienten en kan leiden tot placebo-effecten. Dit zijn echte psychobiologische effecten die niet veroorzaakt worden door een medisch-technische interventie. •Toch is vaak onduidelijk welke communicatieve gedragingen invloed hebben op specifieke uitkomsten bij patienten. •In dit artikel bieden wij inzicht in het mogelijke effect van specifieke communicatie, via specifieke mechanismen, op onder meer de pijnbeleving van patienten. •Uit een recente systematische review en aanvullende literatuur blijkt dat de volgende gedragingen de uitkomsten bij patienten mogelijk beinvloeden: (a) het manipuleren van verwachtingen, (b) het uiten van empathie, en (c) het geven van procedurele informatie. •De placebo-effecten treden waarschijnlijk op via: (a) neurobiologische reacties die vergelijkbaar zijn met het effect van pijnmedicatie, (b) angst- en stressreductie, en (c) vergroting van het gevoel van controle en van vertrouwen in wat er gaat komen (‘self-efficacy’). •Er is meer onderzoek nodig naar de effecten van specifieke communicatie, onder andere in de klinische praktijk, inclusief de mogelijke schadelijke effecten.

Modern medical care is influenced by two paradigms: 'evidence-based medicine' and 'patient-centered medicine'. In the last decade, both paradigms rapidly gained in popularity and are now both supposed to affect the process of clinical decision I making during the daily practice of physicians. However, careful analysis shows that they focus on different aspects of medical care and have, in fact, little in common. Evidence-based medicine is a rather young concept that entered the scientific literature in the early 1990s. It has basically a positivistic, biomedical perspective. Its focus is on offering clinicians the best available evidence about the most adequate treatment for their patients, considering medicine merely as a cognitive-rational enterprise. In this approach the uniqueness of patients, their individual needs and preferences, and their emotional status are easily neglected as relevant factors in decision-making. Patient-centered medicine, although not a new phenomenon, has recently attracted renewed attention. It has basically a humanistic, biopsychosocial perspective, combining ethical values on 'the ideal physician', with psychotherapeutic theories on facilitating patients' disclosure of real worries, and negotiation theories on decision making. It puts a strong focus on patient participation in clinical decision making by taking into account the patients' perspective, and tuning medical care to the patients' needs and preferences. However, in this approach the ideological base is better developed than its evidence base. In modern medicine both paradigms are highly relevant, but yet seem to belong to different worlds. The challenge for the near future is to bring these separate worlds together. The aim of this paper is to give an impulse to this integration. Developments within both paradigms can benefit from interchanging ideas and principles from which eventually medical care will benefit. In this process a key role is foreseen for communication and communication research. (C) 2000 Elsevier Science Ireland Ltd. All rights reserved.