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  • Steven A. Farmer, Debra L. Roter and Irene J. Higginson

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    Florin Tudose
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    This study observed patient-provider interactions for 74 patients presenting with possible acute coronary syndrome in a London emergency department over 12 months. The observations revealed significant obstacles to effective communication for most patients. The three most prominent impediments were the use of leading questions to define chest pain, patient-provider conflict resulting from and contributing to poor communication, and frank miscommunication due to language barriers and translation difficulties. Accurate diagnosis relies on an interaction that incorporates both the patient and physician perspectives to develop a shared understanding, but taking diagnostic shortcuts to overcome educational, cultural, or language barriers may contribute to health disparities. Physicians should take a more careful approach to patient interviewing and be aware of how their questions and focus shape the interaction.

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    chest pain

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    Chest Pain

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    This study observed patient-provider interactions for 74 patients presenting with possible acute coronary syndrome in a London emergency department over 12 months. The observations revealed significant obstacles to effective communication for most patients. The three most prominent impediments were the use of leading questions to define chest pain, patient-provider conflict resulting from and contributing to poor communication, and frank miscommunication due to language barriers and translation difficulties. Accurate diagnosis relies on an interaction that incorporates both the patient and physician perspectives to develop a shared understanding, but taking diagnostic shortcuts to overcome educational, cultural, or language barriers may contribute to health disparities. Physicians should take a more careful approach to patient interviewing and be aware of how their questions and focus shape the interaction.

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    © All Rights Reserved
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    11 views2 pages

    Steven A. Farmer, Debra L. Roter and Irene J. Higginson

    Uploaded by

    Florin Tudose
    This study observed patient-provider interactions for 74 patients presenting with possible acute coronary syndrome in a London emergency department over 12 months. The observations revealed significant obstacles to effective communication for most patients. The three most prominent impediments were the use of leading questions to define chest pain, patient-provider conflict resulting from and contributing to poor communication, and frank miscommunication due to language barriers and translation difficulties. Accurate diagnosis relies on an interaction that incorporates both the patient and physician perspectives to develop a shared understanding, but taking diagnostic shortcuts to overcome educational, cultural, or language barriers may contribute to health disparities. Physicians should take a more careful approach to patient interviewing and be aware of how their questions and focus shape the interaction.

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
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    of 2

    Chest pain: Communication of symptoms and history in a London emergency

    department
    Steven A. Farmer
    a, ,
    , Debra L. Roter
    b
    and Irene J. Higginson
    c

    a
    University of Pennsylvania School of Medicine, Department of Internal Medicine,
    1 Centre!, "# Spruce Street, Philadelphia, P$ 1%1#, US$
    &
    'ohns (op)ins School of Pu&lic (ealth, Department of (ealth Policy *
    Management, +altimore, US$
    c
    ,ing-s College London, Department of Palliative Care * Policy, London, U,
    .eceived // $pril /01 revised 1 Septem&er /01 accepted 12 Septem&er /03
    $vaila&le online / 4cto&er /03
    $&stract
    4&5ective
    6o descri&e patient7provider interactions for patients in an emergency department
    8ith possi&le acute coronary syndrome 9$CS: and to generate hypotheses a&out ho8
    communication might contri&ute to sociocultural disparities in cardiac care3
    Methods
    ;ualitative analysis of o&servational data3 Seventy<four consecutive patients
    presenting &et8een = a3m3 and 1 p3m3 over a #<month period3
    .esults
    Participants 8ere aged #7=0 years1 0=> 8ere male1 ?2> 8ere 8hite, 1=> $fro<
    Cari&&ean, and 10> South @ast $sian3 4&servations revealed significant o&stacles to
    communication for the ma5ority of patients3 6he three most prominent impediments to
    effective communication 8ere: the use of leading Auestions to define chest pain,
    patient7provider conflict as a result of, and contri&utor to, poor communication, and
    fran) miscommunication due to language &arriers and translational difficulties3
    Conclusion
    6his study documents aspects of the communication process that compromise the
    Auality of the medical history o&tained in emergency department patients 8ith
    suspected $CS3 $ccurate diagnosis relies on an interaction that 8eaves &oth the
    patient-s and the physician-s perspective into a shared understanding of events that
    comprise a patient-s history3 Bhen diagnostic short cuts are ta)en to overcome
    educational, cultural, or language &arriers in the medical intervie8, they may
    contri&ute to health care disparities3
    Practice implications
    Physicians should ta)e a more attentive and careful approach to patient intervie8ing
    than 8as o&served here and should &e a8are of the 8ays in 8hich they shape the
    intervie8 through their Auestions and focus3 Cood communication s)ills can &e
    effectively taught at all levels of training and practice3
    Keywords: Provider &ehavior1 Disparities1 @thnicity1 Medical decision ma)ing1
    Communication
    Corresponding author3 6el3: D1 /10 ??/ //1 fa!: D1 /10 =/2 0"%03
    Patient d!cation and "o!nse#ing
    Eolume ?", Issues 1</, 4cto&er /?, Pages 1"=<1##

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