Conversation and Healing Linked : Sociologist Finds Doctor-Patient Misunderstandings

A sociologist who conducted a five-year study of how doctors and patients relate to each other says she found a “communications chasm” that may hinder the healing process.

“In sociable chitchat, the consequences of not being heard or understood can be serious enough,” said Dr. Candace West, professor of sociology at the University of California, Santa Cruz. “In medical encounters, lives may be lost in the wake of misunderstandings between physicians and patients.”

Videotaped Sessions Studied

West studied videotapes of 21 office visits at a family practice center affiliated with a major medical university in the South. She found that male physicians tended to interrupt patients; doctors asked most of the questions and in such a fashion as to limit patients’ answers, and doctor-patient encounters lacked any “social cement” that could facilitate open communication.

“There exists a continuing communications chasm between doctors and patients,” West writes in a 532-page book based on her study, conducted between 1979 and 1984. (“Routine Complications: Troubles With Talk Between Doctors and Patients”; Indiana University Press; 1984; $27.50)

“The encounters I’ve seen suggest a kind of power differential is created through talk that is destructive of what you’re trying to do medically and is destructive of human relationships,” she said in an interview.

West cautions that her study involved only one medical specialty, family practice. The doctors were residents in a three-year training program, which included--with the consent of patients--videotaping of office visits.

West analyzed the recordings, keeping track of laughter, audible exhalations, pitch, amplitude and simultaneous speech.

“A first principle of such analysis is that the details of how something is said--in a whisper, in a shout, with a stutter, with a drawl--can be as important as the content of talk itself,” West said.

She found that “male doctors interrupt their patients far more often than the reverse, and they appear to use interruptions as devices for exercising control in their interactions with patients.”

“There is no evidence to suggest that this pattern of physician-initiated interruption is conducive to patients’ good health,” she said. “If anything, it appears that this sort of control is likely to hinder physicians’ efforts at healing.”

With female doctors, it was the patient who interrupted most of the time, she said.

West also found that 91% of the 773 questions asked during the 21 doctor-patient encounters she studied were initiated by doctors.

“Not only do doctors advance questions which restrict patients’ options for answers, but patients themselves stammer when asking questions of their doctors,” she said.

“The patient who posed most questions to the doctor received proportionately fewest answers. . . . With regard to direct questions, the assertive patient may suffer more than the less insistent counterpart.”

When patients’ questions began with “what?” “you know?” “you mean?” and “really?”--or what she calls expressions of confirmation and surprise--they evoked enthusiastic responses from the physicians.

‘Social Cement’ Lacking

West found a lack of “social cement”--for instance, introductions, greetings, laughter, use of patients’ names--which under normal social conditions brings people closer together.

She found only 49 instances of patient-initiated laughter and 31 of laughter started by the doctor.

Although patients called their doctors by title and surname more often than the reverse, the most common medical encounter was one in which neither party called the other by any name at all, West said.