Observing, selecting, and building with bridging questions: An exploratory microanalysis of clinical interactional curiosity.

Abstract

This study aimed to identify and characterize physicians' observable behaviors that expressed clinical curiosity in medical interactions. This exploratory study used microanalysis of clinical interaction (MCI) to analyze video-recorded routine primary care visits from a University Hospital in the US. Purposive sampling and data saturation were used to define the sample for the study. Three analysts conducted key analytical steps collaboratively: (i) familiarizing with the material, (ii) collecting and selecting relevant observations, (iii) developing a coding manual, and (iv) consensus coding cases and their characteristics. We identified "bridging questions" as a key exemplification of showing clinical curiosity in the interaction, i.e. "physician demonstrations of attentiveness to what patients have said and done, during which they invite the patient to contribute something more in a particular direction". In the five analyzed visits, we found 172 bridging questions (mean of 35 per visit) and 60 discrete clinical interactional curiosity sequences. We analyzed sequences around bridging questions, ending when either the topic changed or the physician made a clinical decision. To offer insight into how physicians use bridging questions, we identified key characteristics: what elicited the bridging question and what the bridging question achieved during the sequence in terms of patient engagement and clinical decisions. Our findings provide insight into ways physicians can make clinical curiosity visible during medical interactions, thus offering a means for clinicians, educators, and researchers to recognize and mobilize a potential display of clinical curiosity when talking with patients. Medical educators might consider teaching bridging questions as a way to mobilize clinical curiosity orienting to what the patient has said and done. While such a communicative action appears simple at first glance, it actually demonstrates that a set of skills is in place: attentiveness, flexibility, and clinical reasoning.