Teaching sexual history taking to health care professionals in primary care.

OBJECTIVES: Although it is accepted that history taking is central to correct diagnosis, little work has been undertaken on the development of sexual history taking, particularly in a primary care context where sexual health may not occur to the patient. Embarrassment is recognized as one major problem. This paper reports on a series of teaching interventions designed to help primary health care professionals (doctors and nurses) to identify and deal effectively with sexual health issues in the consultation. METHODS: 141 participants took part in nine different courses, with 114 returning evaluations. All courses involved tutorial teaching on clinical and ethicolegal issues and role play with trained professional role-players; some involved video-based dramatizations to particularize principles in context. During role play sessions, which were followed by detailed, contextualized feedback, clinical issues, attitudinal issues (e.g. articulating a sense of personal embarrassment, and the risk of stereotyping), and ethicolegal issues were all discussed, as were examples of words and phrases which participants were invited to try out. OUTCOMES: The overall quality of the courses was rated by participants, on average, at 89.95 (maximum 100), and the relevance of the topic at 91.40. Free text comments centred on the power of the training as a consciousness raiser, on the need to alter communication strategies, the need to change existing clinical practice and the value of role play as a methodology. Interactive courses on sexual health are highly acceptable to participants.

Cross-cultural communication in medicine: questions for educators.

Most research into medical communication has had a western setting. It has been undertaken by western researchers and been influential in shaping communication skills curricula. However we know much less about what communication is effective under other circumstances. This article highlights gaps in our knowledge from research in this field, and poses attendant questions for debate by medical educators. We consider the following key aspects of debate on cross-cultural work. (i) To what extent can our understanding of general principles in other cultures be summarized and presented for teaching in a way which does not descend into caricature? Alternatively, can features of other cultures be presented in ways which do not descend into particularity? (ii) Can such paradigms as "patient-centredness" be transferred from culture to culture? Should they be presented across cultures as features of "good" consultations? (iii) What use can be made of the role of interpreters for teaching purposes? What importance does it have to the educator that a doctor may not be a native speaker of the majority language of the culture in which s/he is operating? (iv) Although the language of illness, and particularly metaphors associated with illness, are studied in other cultures, the way in which illness is metaphorized in British English is seldom discussed. What can educators learn and teach from a study of such matters? (v) What are the implications for communication skills teachers of the need to present materials within a culturally diverse environment?

Concordancing: use of language-based research in medical communication.

BACKGROUND: The available literature on medical communication reports almost exclusively on observational, qualitative studies. We aimed to apply a novel approach to the analysis of doctor-patient consultation by means of computer concordancing. This methodology, established in linguistic research but rarely applied to professional language, allows both the quantitative and qualitative study of language. METHODS: We analysed the language of 40 doctors and their patients during 373 complete primary-care consultations. We examined the use of jargon by doctors, the language of power and absence of power, and ways in which language was used to diminish the potential threat of the presenting disorder. FINDINGS: There was no evidence that the doctors used medical jargon. Some doctors used language associated with social power, and some patients used language associated with absence of power. There was substantial evidence that the doctors used language to express emotions (eg, anxiety), to diminish threats (eg, words such as "little"), and to reassure patients. INTERPRETATION: Concordancing is a valuable resource to study the consultation. The finding that doctors do not use jargon suggests that they are aware of the need to avoid it, but it does not follow that they are easily understood by patients. The use of some elements of the language of power may imply that consultations may be less democratic than is appropriate. The language of emotion and diminution is a major part of the primary-care doctor's repertoire and denotes a therapeutic use of language.

Descriptive study of cooperative language in primary care consultations by male and female doctors.

OBJECTIVE: To compare the use of some of the characteristics of male and female language by male and female primary care practitioners during consultations. DESIGN: Doctors' use of the language of dominance and support was explored by using concordancing software. Three areas were examined: mean number of words per consultation; relative frequency of question tags; and use of mitigated directives. The analysis of language associated with cooperative talk examines relevant words or phrases and their immediate context. SUBJECTS: 26 male and 14 female doctors in general practice, in a total of 373 consecutive consultations. SETTING: West Midlands. RESULTS: Doctors spoke significantly more words than patients, but the number of words spoken by male and female doctors did not differ significantly. Question tags were used far more frequently by doctors (P<0.001) than by patients or companions. Frequency of use was similar in male and female doctors, and the speech styles in consultation were similar. CONCLUSIONS: These data show that male and female doctors use a speech style which is not gender specific, contrary to findings elsewhere; doctors consulted in an overtly non-directive, negotiated style, which is realised through suggestions and affective comments. This mode of communication is the core teaching of communication skills courses. These results suggest that men have more to learn to achieve competence as professional communicators.

Imprecision in medical communication: study of a doctor talking to patients with serious illness.

Uncertainty is believed to be a central feature in illness experiences. Conversations between a consultant hematologist and 61 seriously ill patients were transcribed, entered on a database and scrutinized for patterns of language uncertainty by linguistic concordancing analysis. Transcripts were then discussed in detail with the hematologist, and techniques of protocol analysis were used to gain insight into his thought processes during consultations. The main findings were that the doctor used many more expressions of uncertainty than did patients: that evaluative terms were widely used to reassure rather than to worry patients; and that patients and doctor together used certain key terms ambiguously, in a manner which allowed the doctor to feel that facts were not misrepresented while perhaps permitting the patient to feel reassured.

Analysis of primary care staff language about aggression at work using concordancing techniques to identify themes.

OBJECTIVE: We aimed to describe features of language used during interviews about the extent of aggression and violence at work and their effect on primary care staff. METHOD: Forty-four primary health care team members in the West Midlands were interviewed, and interviews were recorded on videotape. The language content of these interviews was analysed using Cobuild concordancing software. Outcome measures used were word frequency, collocation and mutual information (MI) scores for language use. RESULTS: A total of 17517 words spoken by interviewees were analysed. Violence in this sample was perceived as occurring principally in connection with unmet demands for such things as prescriptions and referrals. Only patients were perceived as violent; health care workers used other terms to describe their own feelings and responses. Sixty-eight specific incidents of violence were recounted, features perceived as salient being drink, youth and to a lesser extent mental illness. CONCLUSIONS: Concordancing software can be successfully used in the qualitative examination of videotaped interviews. In this study, the technique rapidly identified a number of perceived training needs among a variety of primary care staff.