Problems with the traditional approach to doctor–patient communication
Traditional models of the communication between health professionals and patients
have emphasized the transfer of knowledge from expert to layperson. Ley’s cognitive
hypothesis model of communication includes a role for the patient and emphasizes
patient factors in the communication process as well as doctor factors such as the pro-
vision of relevant information. This approach has encouraged research into the wider
role of information in health and illness. However, there are several problems with this
educational approach, which can be summarized as follows:
It assumes that the communication from the health professional is from an expert
whose knowledge base is one of objective knowledge and does not involve the health
beliefs of that individual health professional.
Patient compliance is seen as positive and unproblematic.
Improved knowledge is predicted to improve the communication process.
It does not include a role for patient health beliefs.
The adherence model of communication
In an attempt to further our understanding of the communication process, Stanton
(1987) developed the model of adherence. The shift in terminology from ‘compliance’
to ‘adherence’ illustrates the attempt of the model to depart from the traditional view
of doctor as an expert who gives advice to a compliant patient. The adherence model
suggested that communication from the health professional results in enhanced patient
knowledge and patient satisfaction and an adherence to the recommended medical
regime. This aspect of the adherence model is similar to Ley’s model. In addition, how-
ever, it suggested that patients’ beliefs are important and the model emphasized the
patient’s locus of control, perceived social support and the disruption of lifestyle involved
in adherence. Therefore, the model progresses from Ley’s model, in that it includes
aspects of the patients and emphasizes the interaction between the health professionals
and the patients.
However, yet again this model of communication assumes that the health pro-
fessionals’ information is based on objective knowledge and is not influenced by their
own health beliefs. Patients are regarded as laypeople who have their own varying beliefs
and perspectives that need to be dealt with by the doctors and addressed in terms of
the language and content of the communication. In contrast, doctors are regarded as
objective and holding only professional views.
THE PROBLEM OF DOCTOR VARIABILITY
Traditionally, doctors are regarded as having an objective knowledge set that comes from
their extensive medical education. If this were the case then it could be predicted that
doctors with similar levels of knowledge and training would behave in similar ways.
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