What does the structure of a medical consultation look like? A new method for visualising doctor-patient communication.

Abstract

This project developed an innovative methodology for visualising consultation structure by categorising doctor-patient talk into the phases proposed by an established educational model of clinical communication. Consultation phases were identified from verbatim transcripts using the tasks and process skills of the Calgary-Cambridge Guide to the Medical Interview. Seventy-eight simulated consultations from a 'History-taking' station of a postgraduate examination for physicians were analysed by two independent raters. Transcripts were converted into diagrams comprising up to six phases: Initiating, Gathering information, Summary, Explanation, Planning and Closing. The dominant phases were Gathering information, Planning and Explanation (66 %, 10 % and 12 % of talk respectively). While consultations broadly followed the expected chronological sequence, less than a third (23/78) contained all six phases, with Closing and Summary most frequently absent. Half of consultations (40/78) did not include phases in the predicted order, with intertwined phases commonly observed. In this standardised setting, doctors created variable consultation structures, typically omitting phases involving consolidation and agreement of plans going forward. The method enables visualisation and comparison of consultation structure. The findings pose questions about the alignment of practice with educational guidance and the opportunities afforded to patients to actively engage in consultations.