Bernadette Maria Watson

In this study, we explore communication between doctors and patients in health consultations from the doctor's perspective. Traditionally, health communication research has focused on patient perspectives and interpersonal issues in the health context. We argue that, although patient perspectives are important and there are interpersonal aspects, intergroup issues are more salient, and we need to also consider the doctor's views on the health consult. Ten doctors from Australia were interviewed and asked to describe their ideal health consultation, their communication behaviors during consultations, and the challenges they often experience during consultations. For reference and comparison, we asked 20 patients the same questions. Leximancer, a text-mining tool, mapped the key concepts for doctors and patients. Communication accommodation theory (CAT) was used to identify the communication strategies of each group. Analyses revealed that unlike patients, doctors report using several communication strategies in their consultations. More notably, accommodating to patients is not an easy task and doctors tend to employ a blended strategies approach when dealing with challenging patients. We discuss the implications of our findings for improving doctor-patient communication and for the advancement of CAT in the health context.

Original Article When medical consultations are not face-to-face: a pilot study of patient-centred care communication during coronavirus disease 2019 Biyun Li, Bernadette Watson, Amos Yung

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Speaking up for patient safety is a well-documented, complex communication interaction, which is challenging both to teach and to implement into practice. In this study we used Communication Accommodation Theory to explore receivers' perceptions and their self-reported behaviors during an actual speaking up interaction in a health context. Intergroup dynamics were evident across interactions. Where seniority of the participants was salient, the within-profession interactions had more influence on the receiver's initial reactions and overall evaluation of the message, compared to the between profession interactions. Most of the seniority salient interactions occurred down the hierarchy, where a more senior professional ingroup member delivered the speaking up message to a more junior receiver. These senior speaker interactions elicited fear and impeded the receiver's voice. We found that nurses/midwives and allied health clinicians reported using different communication behaviors in speaking up interactions. We propose that the term "speaking up" be changed, to emphasize receivers' reactions when they are spoken up to, to help receivers engage in more mutually beneficial communication strategies.

Background: Within healthcare, the barriers and enablers that influence clinicians’ ability to speak up are well researched. However, despite the receiver of the message being identified as a key barrier to a speaker voicing a concern, there have been very few receiver-focused studies. As a result, little is known about the barriers and enablers that influence message reception. Understanding these can help inform speaking up training and ultimately enhance patient safety through more effective clinical communication.Objectives: To identify enabling or inhibiting factors that influence the receiver’s reception and response to a speaking up message, and if the identified barriers and enablers are related to speaker or receiver characteristics.Design and methods: Twenty-two interdisciplinary simulations were video recorded and transcribed. Simulation participants formed the patient discharge team and were receivers of a speaking up message, delivered by a nurse at the patient’s bedside. How the message was delivered (verbose or abrupt wording), was manipulated and counterbalanced across the simulations. Within the post simulation debriefs, barriers and enablers of being a receiver of a message were explored using content analysis.Setting/participants: This study took place in a large Australian tertiary healthcare setting. Participants were qualified clinicians of varying disciplines and specialties.Results: A total of 261 barriers and 285 enablers were coded. Results showed that how the message was delivered (differing tone, phases, and manner) influenced what receivers identified as barriers and enablers. Additionally, the receiver’s own cognitive processes, such as making positive attributions of the speaker and attempting to build rapport and collegiality, better enabled message reception and response. Receiver behaviour was negatively impacted by listening to fix, rather than understand, and not knowing in the moment how to manage their own reactions and appropriately frame a response.Conclusion: The debriefings identified key barriers and enablers to receiving a speaking up message that differ from those previously identified for senders of the speaking up message. Current speaking up programs are predominately speaker centric. This study identified that both speaker and receiver behaviour influenced message reception. Therefore, training must place equal attention on both the speaker and receiver and be inclusive of experiential conversational rehearsal of both positive and challenging encounters.