Savage and Armstrong (1990)

Question 1

Doctor-centred style

Answer 1

• Impersonal, intent on establishing link between symptoms and organic disorder.
• Asks closed yes/no questions.
• Focuses mainly on first problem.
• Short answers required.
• Tends to ignore attempts to discuss other problems.

Question 2

Patient-centred style

Answer 2

• Personal, less controlling role.
• Open questions allow patient to share more info and introduce new facts.
• Tends to avoid jargon.
• Shares decision making.
• Concluded that a meaningful dialogue led to more compliance.

Question 3

Why is the style of doctor-patient interaction important?

Answer 3

It can affect:
* patient confidence in diagnosis
* whether they adhere to the prescription
* whether they will return to that doctor
* ultimately, whether they will improve and get well.

Question 4

Katon and Kleinman (1980)

Answer 4

Suggested a sharing style is best.

This is where the patient is part of the decision-making as then they have a clearer understanding of the problem and the patient is more likely to follow advice.

Question 5

Inglefinger (1980)

Answer 5

Suggested that a directing style is more likely to make the patient more confident in the diagnosis.

This is when the doctor is authoritative and dominating.

Question 6

Sharing style

Answer 6

The doctor discusses with the patient what they think might be wrong with them and the doctor and patient agree on a course of action.

Question 7

Directing style

Answer 7

The doctor is authoritative and dominating and tells the patient what is wrong with them.

Question 8

Aim

Answer 8

To investigate whether a sharing consultation style increases patient satisfaction compared to a directed style.

Question 9

Independent variable

Answer 9

Whether patients recieved a sharing or directive consultation.

Question 10

Dependent variable

Answer 10

Patients’ questionnaire response as to their satisfaction immediately after the consultation and one week later.

Question 11

Research method

Answer 11

Field experiment.

Question 12

Participants

Answer 12

• 200 randomly sampled patients.
• Aged 16-75.
• From a London GP practice.
• Presenting with any symptoms other than life-threatening or for administrative/preventative measures.

Question 13

Where was the research carried out and for how long?

Answer 13

In a GP surgery in London over 4 months.

Question 14

What did all the participants do before the research took place?

Answer 14

Gave their written consent to take part.

Question 15

How many participants initially took part in the study? How many were used in the final set of data?

Answer 15

395 patients, 200 results were used.

Question 16

How were participants selected?

Answer 16

Through random sampling (a random number generator).

Question 17

How were participants allocated to a directing or sharing style?

Answer 17

A set of cards (with either directive or sharing prompts) were placed face down on the doctor’s desk, then turned over when the patient came in.

Question 17

Directed consultation (example)

Answer 17

• “You are suffering from…”
• “It is essential you take this medication”
• “You should be better in… days”
• “Come and see me in… days”

Question 18

Sharing consultation (example)

Answer 18

• “What do you think is wrong?”
• “Would you like a prescription?”
• “Are there any other problems?”
• “When would you like to come and see me again?”

Question 19

What did patients do after the consultation?

Answer 19

Completed a questionnaire.

Question 20

When were participants asked to complete the questionnaire?

Answer 20

Immediately following the consultation and a week later.

Question 21

What did the independent observer do?

Answer 21

Analysed 40 random tapings of consultations and identified intended style in 39/40.

Question 22

Results

Answer 22

• No significant differences in mean length of consultations between the two styles.
• Only three patients gave neutral or negative responses in regards to the satisfaction levels of their consultation.

Question 23

Conclusions

Answer 23

• Patients with simple physical illnesses benefit more from a directed style of consultation.
• Directed style did not provide greater satisfaction during longer advisory consultations when patients had chronic or psychological illnesses.
• Patients prefer certainty paternalism- doctor to be the authority figure.

Question 24

Strengths

Answer 24

• High ecological validity = real-life setting with a real doctor and patients suffering from real health problems.
• Random sampling = ensures objectivity/less bias and sample was diverse.
• High validity and reliability = questionnaire repeated a week later.
• Standardised procedure = increased internal validity since consultation style changes were the only thing being measured.
• RWA

Question 25

Criticisms

Answer 25

• Individual differences = may not take into account participant variables that could affect their satisfaction levels.
• Quantitative data = no explanation/qualitative reasoning for why a style of consultation was more satisfying than the other.
• Limited sample/cultural bias = participants all from one surgery in London.
• Researcher bias? = age/gender of the doctor may have affected how satisfied patients were.

Question 26

How do Savage and Armstrong’s findings have RWA?

Answer 26

Shows that doctors should be aware of their style of communication and the appropriate technique for the setting they are working in when dealing with a patient.

Question 27

How do S and A’s findings display situational and individual explanations?

Answer 27

Patients were found to like a more direct, authoritative style.