is wrong?’; ‘Would you like a prescription?’; ‘What do these symptoms or problems
mean to you?’) and ‘directing’ (e.g. ‘This is a serious problem’; ‘You are suffering from
X’; ‘It is essential that you take this medicine’; and ‘You should be better in Xdays’).
In all cases patients were allowed to complete their explanation of the problem and
more than 80 per cent of those receiving each style reported that they had been able
to discuss their problem well. Thus phase 2 in the Byrne and Long model was
completed. The researchers found that a ‘directing’ style was associated with greater
patient confidence that their doctor had understood their problem, perception of higher
quality explanation by the doctor and greater reported health improvement one week
later – but only among patients consulting about a physical problem or receiving a
prescription. Among patients with a long-term or psychological illness and among those
not receiving a prescription there was no difference between the two consulting styles.
These findings mirror those of Little and colleagues emphasizing that, while patients
need to be listened to, they expect positive, unambiguous expert advice from doctors
reflecting their medical understanding of illness and treatments. However, where the
problem has no clear physical diagnosis or cannot be treated using biomedical
prescriptions a sharing style is likely to be especially beneficial to patient satisfaction
and adherence. This does not mean that patient-centredness is unimportant for acute
patients for whom there is a known remedy. As we have seen, the evidence suggests
that patient-centred collaboration promotes adherence for all patients. However the
degree of sharing and the extent of the therapeutic alliance required may differ across
patients and may depend on the complexity of the problems that the patient and health
care professional are facing. Training in patient-centredness could help health
professionals with these assessments.
Patient empowerment
We have seen that communication and patient-centredness training can help health
professionals manage consultations more effectively. Can we also empower patients in
their interactions with health care professionals? On balance, the evidence suggests that
we can. Robinson and Whitfield (1985) gave patients written information before their
consultation reminding them that people may regret not asking questions after the
consultation, advising them to check their understanding of instructions and the
feasibility of those instructions and advising patients to ask about any discrepancies
between recommendations made by the doctor and what they had expected.
Compared to controls, these patients asked more questions in the consultation and gave
more complete and accurate accounts of the recommended treatments after the
consultation. Similarly, Cegala et al. (2000) found that patients receiving a training
booklet designed to enhance patients’ communication skills engaged in more effective
information seeking, provided more detailed information about their condition to their
doctor and used more summarizing utterances to check information provided by the
doctor. Less encouraging results were reported by Kidd et al.(2004), who found that
an intervention in which patients talked to a researcher about three or more questions
they wanted to ask and were encouraged to rehearse these questions, did not increase
question asking in the consultation. However, these researchers noted that question
asking was higher than usual among their control group patients. The intervention
did enhance self-efficacy to ask questions but had no impact on health outcomes. In
242 RELATING TO PATIENTS