What do people appreciate in physicians' communication? An international study with focus groups using videotaped medical consultations

Background The literature shows that the quality of communication is usually determined from a professional perspective. Patients or lay people are seldom involved in the development of quality indicators or communication. Objective To give voice to the lay people perspective on what constitutes ‘good communication’ by evoking their reactions to variations in physician communication. Design Lay people from four different countries watched the same videotaped standardized medical encounters and discussed their preferences in gender-specific focus groups who were balanced in age groups. Setting and participants Two hundred and fifty-nine lay people (64 NL, 72 IT, 75 UK and 48 BE) distributed over 35 focus groups of 6–8 persons each. Main variables studied Comments on doctors’ behaviours were classified by the GULiVer framework in terms of contents and preferences. Results Participants prevalently discussed ‘task-oriented expressions’ (39%: competency, self-confident, providing solutions), ‘affective oriented/emotional expressions’ (25%: empathy, listening, reassuring) and ‘process-oriented expressions’ (23%: flexibility, summarizing, verifying). ‘Showing an affective attitude’ was most appreciated (positive percentage within category: 93%, particularly facilitations and inviting attitude), followed by ‘providing solution’ (85%). Among disfavoured behaviour, repetitions (88%), ‘writing and reading’ (54%) and asking permission (42%) were found. Conclusions Although an affective attitude is appreciated by nearly everybody, people may vary widely in their communication needs and preferences: what is ‘good communication’ for one person may be disliked or even a source of irritation for another. A physician should be flexible and capable of adapting the consultation to the different needs of different patients. This challenges the idea of general communication guidelines.