of smoking behaviour, 50 per cent of individuals thought that lung cancer caused by
smoking had a good prognosis. Roth also reported that 30 per cent of patients believed
that hypertension could be cured by treatment.
If the doctor gives advice to the patient or suggests that they follow a particular
treatment programme and the patient does not understand the causes of their
illness, the correct location of the relevant organ or the processes involved in the
treatment, then this lack of understanding is likely to affect their compliance with this
advice.
FOCUS ON RESEARCH 4.1: TESTING A THEORY – PATIENT SATISFACTION
A study to examine the effects of a general practitioner’s consulting style on
patient satisfaction (Savage and Armstrong 1990).
This study examined the effect of an expert, directive consulting style and a sharing
patient-centred consulting style on patient satisfaction. This paper is interesting for both
methodological and theoretical reasons. Methodologically, it uses a random control
design in a naturalistic setting. This means that it is possible to compare the effects of the
two types of consulting style without the problem of identifying individual differences
(these are controlled for by the design) and without the problem of an artificial experi-
ment (the study took place in a natural environment). Theoretically, the study examines
the prediction that the educational model of doctor–patient communication is problem-
atic (i.e. is the expert approach a suitable one?) and examines patient preferences for the
method of doctor–patient communication.
Background
A traditional model of doctor–patient communication regards the doctor as an expert
who communicates their ‘knowledge’ to the naïve patient. Within this framework, the
doctor is regarded as an authority figure who instructs and directs the patient. However,
recent research has suggested that the communication process may be improved if a
sharing, patient-centred consulting style is adopted. This approach emphasizes an inter-
action between the doctor and the patient and suggests this style may result in greater
patient commitment to any advice given, potentially higher levels of compliance and
greater patient satisfaction. Savage and Armstrong (1990) aimed to examine patients’
responses to receiving either a ‘directive/doctor-centred consulting style’ or a ‘sharing/
patient-centred consulting style’.
Methodology
Subjects The study was undertaken in a group practice in an inner city area of
London. Four patients from each surgery for one doctor, over four months were
DOCTOR–PATIENT COMMUNICATION 79