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Clayman - IWHR For AWHI
Clayman - IWHR For AWHI
18 May 2010
Marla L. Clayman, PhD MPH
Division of General Internal Medicine
Why do we care about communication in
the provider-patient relationship?
Over 900 million ambulatory physician office visits each year (NAMCS
2006 summary)
• Non-verbal communication
Patient-provider communication and
physician gender
• Female physicians engage in more:
• Partnership
• Positive talk
• Psychosocial counseling
• Psychosocial question asking
• No differences by physician gender for amount, quality, or
manner of biomedical information giving.
Female patients:
• give more information
• ask more questions
• use more back-channels
- Un-huh, yeah, I see
- (see Roter and Hall 2006 for a summary)
In these cases, patients were more than four times as likely to be active
in decision-making as patients whose companions did not assist in this
manner (Clayman et al. 2005 Soc Sci Med)
As a healthcare provider
• Increases recall
• Recognize that terms like “high risk” and “low risk” are arbitrary and
mean different things in different contexts
Electronic prescribing
A frequency statement:
"Three out of every 10 patients have a side effect from this drug"
Conditional probabilities
The probability that a woman has breast cancer is 0.8%. If she has
breast cancer, the probability that a mammogram will show a positive
result is 90%. If a woman does not have breast cancer the probability of a
positive result is 7%. Take, for example, a woman who has a positive
result. What is the probability that she actually has breast cancer?
As natural frequencies
Eight out of every 1000 women have breast cancer. Of these
eight women with breast cancer, seven will have a positive
result on mammography.
No.
•Some communication skills can be taught and learned
- Giving bad news, communicating risk
But, we need to think about when to place burden on
• physicians vs.
• patients vs.
• both vs.
• Other health care professionals or lay health educators