Communication - Publications

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https://dspace.uohyd.ac.in/handle/1/92

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Browsing Communication - Publications by Author "Holden, Brien"
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    Clinician-patient communication in a glaucoma clinic in India
    ( 2011-03-01) Mocherla, Shobha ; Raman, Usha ; Holden, Brien
    We compiled data from nonparticipant observations of clinician-patient communication in clinical interactions in a tertiary care eye hospital in India. Applying elements of the French philosopher Michel Foucault's concept of power and knowledge, we deconstructed the structuring and moderating influences on the expert/nonexpert dyad. We found that clinicians enforce their "disciplining power" through varying degrees of communicativeness to bring about compliance in the patient. Clinicians appear to classify the patient as "participant" or "deviant" based on the patient's "internalization" of instructions, and then communicate in predictable ways with the patient. Patients can also wield power, communicating it by understanding and following or not understanding and not clarifying/verifying instructions in the clinic, and thereafter failing to comply with the clinician's advice. We suggest that clinicians need to hone their communication skills both to optimally utilize interactions in the clinic and to encourage patient compliance, thereby making possible better treatment outcomes. © The Author(s) 2011.
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    Expressions of equity: imbalances in the patient-clinician interaction.
    ( 2012-01-01) Mocherla, Shobha ; Raman, Usha ; Holden, Brien
    This paper reports patient perceptions of inequities in the doctor-patient interaction. A mixed method study was conducted in a tertiary eye care centre in southern India to gain an insight into patient understanding and satisfaction from clinician communication. Non-participant observations enabled us to map the sequence of communication opportunities in the clinical interaction, and in-depth interviews were used to identify patient perceptions of the content and clarity of clinician communication in a clinic for patients of glaucoma, a chronic eye disease. A 60-item instrument was administered to 550 participants in the quantitative phase to explore associations between patient expectations, experience and ratings of clinician communication and satisfaction with it. The qualitative results helped map the clinical interaction, highlighting the consequences of poor clinician communication. The quantitative phase showed that patients expected explanations about the disease, the opportunity to ask questions, receiving supportive signals, and being treated as equals. Most patients stated their information source on disease was their doctor, leading us to conclude that clinicians must utilise communication opportunities optimally to ensure every patient has an equal chance to correctly understand their disease and role in treatment. By consciously improving their communication and using it strategically, clinicians can help ensure effective treatment outcomes.