Clinician communication associated with diabetic patients' comprehension of their therapeutic regimen.

The purpose of this study was to identify the types of statements used by medical and nursing clinicians in encounters with diabetic outpatients that are associated with accurate comprehension of their therapeutic regimen. Encounters between 19 clinicians and 29 patients followed in an urban diabetes clinic were examined. Statements made by clinicians were classified by trained observers according to an 11-category observation scheme. Immediately after the encounters, each patient was interviewed and asked to recall his or her regimen as just discussed. Recall was verified by review of a videotape of the encounter. By use of multiple discriminant analysis, a combination of three types of statements by clinicians was found to predict high (better than 80%) comprehension by patients: demonstrating respect, sharing current clinical data, and acknowledging patient statements (inversely). Insofar as patient comprehension of the diabetic regimen is a prerequisite for compliance with that regimen, this study suggests that the chances for therapeutic success are increased when the interaction of clinician and patient takes a certain tone. Most importantly, the clinician should be informative. Current laboratory and physical findings should be shared with the patient in order to make more obvious the successes and failures of recent attempts at compliance. As suggested in previous research, this information should have its strongest effect when conveyed in a nonthreatening manner.

Getting the message across.

Messages do not simple 'get across'. The author points out the importance (1) of seeing good communication as an effort of understanding between human beings and (2) of dismissing any idea of a single communicator's skill. There are many and different skills to be applied.

Use of vignettes to elicit responses toward broad concepts.

Use of vignettes in a measuring instrument is a valid and desirable method of elicting responses toward broad concepts. Ambiguities of any type should be given considered attention in the establishing of validity.