Listening in on doctor-patient consultations
Nearly 200 consultations in doctors’ offices have now been transcribed and made available for extensive research. Early studies show the difficulties doctors face discussing existential issues with their patients.
The ultimate consequence of the conversations held in a doctor’s office can be a matter of life or death. The information discussed can be earth-shattering. A simple consultation can have a major effect on the mental and physical qualities of a person’s life.
But what actually happens during the private discussions between doctors and their patients?
Clear communication at the doctor’s office is crucial. Nevertheless, relatively little research has been conducted on the conversations between doctors and their patients at hospitals, according to Professor Pål Gulbrandsen of the Institute of Clinical Medicine at the University of Oslo (UiO).
That is, until now.
A study that has its roots in linguistics research has now been opened up to a broader pool of researchers to examine some of the nuances of some of those private sessions.
Videos of consultations
Linguistic technologists at UiO’s Text Laboratory, a part of the Department of Linguistics and Scandinavian Studies, have made 194 doctor-patient consultations anonymous and available to anyone who wishes to use them for research. The discussions have been transcribed from video recordings during consultations between patients and specialists at Norway’s Akershus University Hospital.
The recordings were made in connection with a study of the efficacy of a communications course given to doctors. But the researchers immediately realised that the conversations provided unique opportunities for further research.
As the patients and doctors could be identified on the videos, the material was highly sensitive. The use of them was strictly limited and the recordings were to be erased after a certain amount of time.
But transcribing the consultations and removing all the information that could compromise the participants has preserved the material and made it available to researchers.
Already provided lots of answers
Gulbrandsen says that the material has already formed the basis of 11 different research articles.
“One of them, for instance, shows how doctors tackle some of the existential questions that crop up during the consultations.”
The video recordings reveal that many doctors tend to skirt such issues.
“I remember a conversation between a doctor and a relatively young patient with incurable cancer. The doctor talked about the choice between two different types of treatment but it comes to light that none of them will help. The patient doesn’t stand a chance, but the doctor avoids saying it,”Gulbrandsen says.
“It wasn’t until the end of the consultation that the patient asks: ‘Will I survive this?’ She has had this question on the tip of her tongue the entire time, but the doctor evaded it during the conversation.”
Good communication too
Other researchers have studied cases in the texts where doctors have solved difficult situations for their patients with excellent communication techniques.
Gulbrandsen’s prime interest is improving communication between physicians and patients.
A researcher in communications, Jan Svennevig, says the material can also provide general knowledge about the language used in these very significant situations, and suggests several examples of themes for future research.
How do various patients present their case, do they trivialise it or do they exaggerate it? What happens with the language in encounters between doctors and patients who have different native tongues?
“Right now Research Fellow Anne Marie Landmark Dalby is working on a PhD thesis about the ways doctors and patients agree on a treatment regimen,” says Svennevig.
“Ideally the patient is supposed to take part in the choice of treatment. But doctors have little education about how such discussions should be carried out,” he says.
“In many cases, patients find it hard to weigh the pros and cons of the various treatment alternatives. They end up asking the doctor to make the decision.”
A quick dive into the material can reveal fascinating phenomena.
“I did a search using the key word ‘dø’ [die],” says Gulbrandsen.
“Many of these patients have serious diseases and it would be natural to talk about death. But the word hardly ever arises, and when it does, it is usually about other people’s deaths.”
Doctors and semanticists
The researchers think there is much to be gained if scholars from a broad array of disciplines, such as linguistics, medicine and ethics, cooperated on projects using the material.
“We benefit richly from working with linguists,” says Gulbrandsen.
“Doctors might think about the content or about empathy expressed in their consultations. But we haven’t examined our language on the micro-level. It can make a big difference if the doctor asks: ‘Have you been very worried?’ rather than ‘So, have you been very worried?’ The little word ‘so’ sends a signal that the doctor is understanding and sensitive.”
“This is crucial knowledge that we often don't have,” Gulbrandsen said.
Translated by: Glenn Ostling