Confusion in and about shared decision making in hospital outpatient encounters.

OBJECTIVE: To explore how physician efforts to involve patients in medical decisions align with established core elements of shared decision making (SDM). METHODS: Detailed video analysis of two hospital outpatient encounters, selected because the physicians exhibited much effort to involve the patients in decision making, and because the final decisions were not what the physicians had initially recommended. The analysis was supplied by physician, patient, and observer-rated data from a total of 497 encounters collected during the same original study. The observer-rated data confirmed that these physicians demonstrated above average patient-centred skills in this material. RESULTS: Behaviours of these two not trained physicians demonstrated confusion about how to perform SDM. Information provided to the patients was imprecise and ambiguous. Insufficient patient involvement did not prompt the physicians to change strategy. Physician and patient reports indicated awareness of suboptimal communication. CONCLUSION: Inadequate SDM in hospital encounters may introduce confusion. Quantitative evaluations by patients and observers may reflect much effort rather than process quality. PRACTICE IMPLICATIONS: SDM may be discredited because the medical community has not acquired the necessary skills to perform it, even if it is ethically and legally mandated. Training and supervision should follow regulations and guidelines.

Gestures convey content: an exploration of the semantic functions of physicians' gestures.

OBJECTIVES: Gestures' semiotic role in clinical interactions is unexplored. Using theoretical underpinnings from basic research on gesture, our objective was to investigate the semantic contributions of physicians' gestures during interactions with patients with a different native language. METHODS: We analyzed gestures-speech composites in eight videotaped interactions between physicians and patients during treatment plan discussions. Using microanalysis of face-to-face dialogue and conversation analysis, we identified physicians' gestures, decided whether they served semantic functions, and explored their relationship with the accompanying speech. RESULTS: Using the operational definitions developed here resulted in high reliability. Physicians gestured at a mean rate of 6.5 gestures per 100 words. Approximately half of the gestures served semantic functions, with referents that were concrete (e.g., actions, body parts) and abstract (e.g., regularity, timelines). Gestures conveyed topic information, but speech conveyed information about that topic and context for interpreting gestures' meaning. CONCLUSION: Analyzing the semantic functions of gestures in clinical interactions is feasible. Physicians' gestures and speech formed integrated messages; the two modalities conveyed mutually dependent meanings. PRACTICE IMPLICATIONS: Physicians could become aware of the semiotic potential of gestures. However, conversational gestures lack conventional meanings and rely on the accompanying speech to provide necessary context for interpreting their meaning.