Abstract
PURPOSE We undertook a study to observe in detail the primary care interactions and communications of patients with newly diagnosed diabetes over time. In addition, we sought to identify key points in the process where miscommunication might occur.
METHODS All health interactions of 32 patients with newly diagnosed type 2 diabetes were recorded and tracked as they moved through the New Zealand health care system for a period of approximately 6 months. Data included video recordings of patient interactions with the health professionals involved in their care (eg, general practitioners, nurses, dietitians). We analyzed data with ethnography and interaction analysis.
RESULTS Challenges to effective communication in diabetes care were identified. Although clinicians showed high levels of technical knowledge and general communication skill, initial consultations were often driven by biomedical explanations out of context from patient experience. There was a perception of time pressure, but considerable time was spent with patients by health professionals repeating information that may not be relevant to patient need. Health professionals had little knowledge of what disciplines other than their own do and how their contributions to patient care may differ.
CONCLUSIONS Despite current high skill levels of primary care professionals, opportunities exist to increase the effectiveness of communication and consultation in diabetes care. The various health professionals involved in patient care should agree on the length and focus of each consultation.
Footnotes
Conflicts of interest: authors report none.
Funding support: The study was funded by the Health Research Council of New Zealand.
Author contributions: T.D., M.S., K.D., L.M., T.K., and N.S. designed the study. L.M., N.S., B.D., D-A.H., L.G., D.R., and R.T. undertook fieldwork and data collection/processing. L.M., S.V., and R.T. viewed and reviewed recorded data and made written summaries of each item and collated cases. All authors contributed to the data analysis. T.D. and M.S. drafted the manuscript, and all authors read and approved the final manuscript.
Previous presentations: Aspects of these findings have been presented at the European Association of Communication in Health conference; September 2010; Verona, Italy; the New Zealand Medical Association annual GP conference; June 2011; Rotorua, New Zealand;; the Conversation Analysis of Clinical Encounters conference; July 12–14, 2011; York, United Kingdom; and the Annual Scientific and General Meeting of the New Zealand Society for the Study of Diabetes; May 2012; Queenstown, New Zealand.
- Received for publication March 3, 2013.
- Revision received May 24, 2017.
- Accepted for publication June 23, 2017.
- © 2018 Annals of Family Medicine, Inc.
