The Issue
The quality of the doctor-patient relationship is a major determinant of whether or not patients' expectations will be met and favourable health outcomes achieved. Current thinking on models of healthcare reflects an ever-growing shift away from the traditional paternalistic models of the doctor-patient relationship, towards more patient-centred models that involve patients in decision-making and focus on the wider psychosocial issues, which influence the illness experience. Patients' preferences in relation to the kind of communication style they want from their doctors tend to vary and are dependent upon various factors, including the type and severity of the problem. The project is focused on the issue of how doctors can match their consultation style to what each individual patient wants in terms of involvement.

Patient-Centred
Thirteen Oxfordshire GPs and 171 patients attending for routine appointments took part in the study. Patients gave their consent to have their consultation video recorded and completed a post-consultation, decision preference, questionnaire which asked whether they wanted: (a) the doctor to make decisions for them; (b) to share decisions with the doctor; or (c) to make decisions themselves, although based on information from the doctor. Patients were also asked for their perceptions of the level of involvement they actually achieved during the consultation.

Patients who preferred the doctor to make decisions for them were more likely to have their preferences met compared to patients wishing to share decisions or to patients wishing to make their own decisions. In total, 61% of patients perceived that they achieved their preferred decision-making role. A key finding was that some doctors are able to adapt their style to suit each patient, whereas others are not. This is contrary to the widespread belief that almost all doctors stick to a rigid communication style with all patients.

Rooted in the real world
As described above, much of the data collected in this project have been the preferences of real patients visiting their general practitioner. In addition, the videotaped consultations have provided a valuable insight into how GPs tend to communicate with their patients.

To improve communication skills teaching
The video recordings will enable us to observe the style and techniques used by those doctors who met their patients' preferences. These will be rated using a standardised rating scale designed previously by us to assess evidence-based patient choice in the consultation. This will provide us with an objective view of what occurred in each patient's consultation, which we can then compare with patients' subjective views of what happened. This will enable us to incorporate those behaviours that facilitate doctors to meet their patients' preferences during consultations into existing measures for assessing medical students' communication skills. We will also be examining differences in behavioural styles between doctors who met their patients' expectations and those who did not. This will help us develop better communication skills teaching.

Outputs
Three papers have already been published in peer reviewed, internationally respected academic journals with more to follow.

To further the discipline of medical communication skills
This research has sought the preferences of patients in order that these may be taken into account when developing new models of the consultation. It is our intention is to produce a feasible but broad ranging method for assessing the ability of doctors to meet their patients' decision-making preferences.