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To investigate how clinicians correct patient misconceptions, we analyzed 23 video recordings of primary care visits. Analysis focused on operationalizing, identifying, and characterizing clinician corrections, integrating two inductive approaches: microanalysis of clinical interaction and conversation analysis. According to our definition, patient misconception-clinician correction episodes met three essential criteria: (1) the clinician refuted something the patient had said, (2) which the patient had presented without uncertainty, and (3) which contained a proposition that was factually incorrect. We identified 59 such episodes; the patient misconceptions most commonly related to medication issues; fewer than half had foreseeable implications for patients' future actions. We identified seven clinician correction practices: Three direct practices (displaying surprise, marking disagreement, contradicting the patient) and four indirect practices (presenting the correct proposition, providing explanations, invoking an outside authority, demonstrating with evidence). We found an almost equal distribution of these direct and indirect practices.

Background: Information exchange between physician and patient is crucial to achieve patient involvement, shared decision making and treatment adherence. No reliable method exists for measuring how much information physicians provide in a complex, unscripted medical conversation, nor how much of this information patients recall. This study aims to fill this gap by developing a measurement system designed to compare complex orally provided information to patient recall., Methods: The development of the complex information transfer measurement system required nine methodological steps. Core activities were data collection, definition of information units and the first draft of a codebook, refinement through independent coding and consensus, and reliability testing. Videotapes of physician-patient consultations based on a standardized scenario and post-consultation interviews with patients constituted the data. The codebook was developed from verbatim transcriptions of the videotapes. Inter-rater reliability was calculated using a random selection of 10% of the statements in the transcriptions., Results: Thirtyfour transcriptions of visits and interviews were collected. We developed a set of rules for defining a single unit of information, defined detailed criteria for exclusion and inclusion of relevant units of information, and outlined systematic counting procedures. In the refinement phase, we established a system for comparing the information provided by the physician with what the patient recalled. While linguistic and conceptual issues arose during the process, coders still achieved good inter-rater reliability, with intra-class correlation for patient recall: 0.723, and for doctors: 0.761. A full codebook is available as an appendix., Conclusions: A measurement system specifically aimed at quantifying complex unscripted information exchange may be a useful addition to the tools for evaluating the results of health communication training and randomized controlled trials.

Introduction: Occasionally mishaps in an investigation lead to new understandings. We report how a videotaped emotional discussion among a family after they had received information about their relative's state gave us insight into the minute sources of uncertainty that fueled their confusion., Methods: Based on the themes of the family's discussion, we used a forensic approach to locate distinct sequences of interest in the video and transcript. Microanalysis of face-to-face dialogue was performed to understand the most critical sequence. The analysis was supported by questionnaire data., Results: The family's disagreement about the patient's prognosis could be traced to minor differences in how the surgeon and the anesthesiologist had framed the information. In attempting to resolve apparent contradictions, the family realized they were uncertain about the physicians' roles, which amplified the emotional expressions in the discussions. Role confusion could be traced to subtle details in the surgeon's presentation of himself and the surgery., Conclusion: Minor discrepancies in how health care professionals frame information combined with not exploring relatives' emotions may lead to major differences in relatives' perceptions. Doubt about health providers' roles decontextualizes information and reassurance, magnifying uncertainty., Practice Implications: Health providers should present themselves clearly without haste. If more than one provider is involved, joint preparation of the main messages may be necessary., (Copyright © 2017. Published by Elsevier B.V.)

Objective: Physicians and patients discuss treatment plans. If tasks within plans are not described adequately, patients cannot adhere. We evaluated task descriptions, testing whether patient engagement and language barriers affected task clarity., Method: We sampled 12 videotaped hospital interactions from a corpus of 497: two encounters each from six hospital physicians, interacting with one native-speaking and one non-native-speaking patient. We used microanalysis of face-to-face dialogue to assess whether the physicians and patients achieved a complete, clear description of each task's three core information elements (who should do what and when)., Results: We conducted detailed analysis on 78 of the 90 tasks. Core information elements were complete in 62 (0.79) and clear in 37 (0.47). Language barriers had no effect on task clarity. When native-speaking patients were engaged, tasks were clearer (p<0.05). Although non-native-speaking patients were significantly more engaged (p<0.01), their engagement had no effect., Conclusion: Physicians may be pursuing patients' agreement, motivation, and commitment at the expense of working with the patient to be clear about what needs to be done., Practice Implications: Physicians need to improve how clearly they present basic task information. Previous research demonstrated that even a short course can significantly improve the clarity of instructions., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

Objective: To define and operationalize three taught strategies for providing information in interactions with patients using videos collected in a randomized controlled trial (RCT).Methods: This was a qualitative exploratory study embedded in a randomized controlled design, using microanalysis of face-to-face dialogue as an inductive video analysis method to operationalize physicians' use of three information-provision strategies. Data were 34 video-recorded simulated (but unscripted) interactions between 17 physicians and 34 multiple sclerosis patients collected before and after a brief course on information provision. We operationalized (1) mapping the patient's preferences and (2) checking the patient's understanding, and pauses indicative of (3) portioning information.Results: Results are detailed analytical definitions, criteria, and assessable, quantifiable outcomes for each of the three strategies. Patients responded to portioning pauses as expected: whereas 91% of these pauses elicited an immediate patient response, only 23% of non-portioning pauses did so.Conclusion: Our methods revealed how to define and evaluate information sharing strategies physicians used within the contingencies of clinical interaction.Practice Implications: Findings provide applicable methods to teach, analyze, and evaluate information sharing strategies and indications for further training. [ABSTRACT FROM AUTHOR]