Miscommunication in Doctor-Patient Communication.

The effectiveness of medical treatment depends on the quality of the patient-clinician relationship. It has been proposed that this depends on the extent to which the patient and clinician build a shared understanding of illness and treatment. Here, we use the tools of conversation analysis (CA) to explore this idea in the context of psychiatric consultations. The CA "repair" framework provides an analysis of the processes people use to deal with problems in speaking, hearing, and understanding. These problems are especially critical in the treatment of psychosis where patients and health care professionals need to communicate about the disputed meaning of hallucinations and delusion. Patients do not feel understood, they are frequently non-adherent with treatment, and many have poor outcomes. We present an overview of two studies focusing on the role of repair as a mechanism for producing and clarifying meaning in psychiatrist-patient communication and its association with treatment outcomes. The first study shows patient clarification or repair of psychiatrists' talk is associated with better patient adherence to treatment. The second study shows that training which emphasizes the importance of building an understanding of patients' psychotic experiences increases psychiatrists' self-repair. We propose that psychiatrists are working harder to make their talk understandable and acceptable to the patient by taking the patient's perspective into account. We conclude that these findings provide evidence that repair is an important mechanism for building shared understanding in doctor-patient communication and contributes to better therapeutic relationships and treatment adherence. The conversation analytic account of repair is currently the most sophisticated empirical model for analyzing how people construct shared meaning and understanding. Repair appears to reflect greater commitment to and engagement in communication and improve both the quality and outcomes of communication. Reducing potential miscommunication between psychiatrists and their patients with psychosis is a low-cost means of enhancing treatment from both the psychiatrist and patient perspective. Given that misunderstanding and miscommunication are particularly problematic in psychosis, this is critical for improving the longer term outcomes of treatment for these patients who often have poor relationships with psychiatrists and health care services more widely.