more expectations met was related to a higher level of satisfaction with the consultation.
However, this study did not explore compliance, nor did it examine whether the GP and
patient had a shared belief about the nature of the consultation. Therefore, further
research is needed to develop methodological and theoretical approaches to the con-
sultation as an interaction. In addition, research is needed to explore whether the
nature of the interaction and the level of the agreement between health professional and
patient predicts patient outcomes.
TO CONCLUDE
Traditional educational models of doctor–patient communication emphasized patient
factors and considered non-compliance to be the result of patient variability. The
relationship between health professionals and patients was seen as the communication
of expert medical knowledge from an objective professional to a subjective layperson.
Within this framework, Ley’s model explained failures in communication in the context
of the failure to comply in terms of patient factors, including patient’s satisfaction,
lack of understanding, or lack of recall. In addition, methods to improve the communica-
tion focused on the health professional’s ability to communicate this factual knowledge
to the patient. However, recent research has highlighted variability in the behaviours
of health professionals that cannot simply be explained in terms of differences in
knowledge. This variability can be examined in terms of the processes involved in clinical
decision making by the health professional and in particular the factors that influence
the development of hypotheses. This variability has also been examined within the
context of health beliefs, and it is argued that the division between professional and
lay beliefs may be a simplification, with health professionals holding both professional
and lay beliefs; health professionals have beliefs that are individual to them in the way
that patients have their own individual beliefs. However, perhaps to further conceptualize
the communication process, it is important to understand not only the health pro-
fessional’s preconceived ideas/prejudices/stereotypes/lay beliefs/professional beliefs or
the patient’s beliefs, but to consider the processes involved in any communication
between health professional and patient as an interaction that occurs in the context of
these beliefs.
? QUESTIONS
1 Health professionals’ decisions are based on knowledge. Discuss.
2 What are the problems with the hypothetico-deductive model of decision-
making?
3 Discuss the role of health professionals’ beliefs in the communication process.
4 To what extent is non-compliance the responsibility of the patient?
5 Shared beliefs are essential for improving patient outcomes. Discuss.
6 Describe a research project designed to evaluate health professionals’
beliefs.
DOCTOR–PATIENT COMMUNICATION 95