Addressing patient beliefs and expectations in the consultation

In this article, we specifically focus on the identification and management of patient beliefs and expectations during consultations with health-care professionals (HCPs). In examination of the nature and purpose of communication during consultations, we evaluate the research relating to doctor–patient communication, present the Calgary–Cambridge framework and highlight the identification and management of the patient’s beliefs and expectations as a key part of this process. Having identified what can go wrong, we identify the characteristics of effective consultations and consider strategies for improving communication. In recommending a clear and more focussed approach to the identification and management of patient beliefs and expectations, we consider not only the nature of the therapeutic climate, but also the style and content that could enhance the effectiveness of the communication. Having identified techniques for facilitating self-disclosure, we conclude by offering suggestions on how to ‘close down’ the consultation and hand over responsibility to the patient.

Patient beliefs and expectations, as potential influences on adherence, precursors of behaviour change and mediators of outcome, are at the heart of the consultation process. Their identification and management can be understood and addressed only within the overall context of the consultation itself. According to Gask and Usherwood , there are three major features of the consultation: (1) the style with which a doctor listens to a patient will influence what they say; (2) effective communication between doctor and patient leads to improved outcome for many common diseases; and (3) patients’ compliance will be improved if the management plan has been negotiated jointly. To optimise the effectiveness of the consultation therefore, it is necessary to clarify the nature and purpose of the consultation.

The nature of the consultation

The communication process has been widely researched in the context of medical teaching and training and the most detailed and all-encompassing framework is provided in the Calgary–Cambridge Guides in which 71 specific elements (skills) are nested within a broader framework of process skills, outlined in Box 1 .

Box 1. Key structure of the Calgary–Cambridge framework for consultation

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Initiating the session
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Gathering information
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Providing structure to the consultation
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Building relationship
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Explanation and planning
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Closing the session

The key principles behind the approach are a blending of the biomedical (disease) perspective with the patient (illness perspective) within the context of background medical, personal and social history. Core evidence-based skills are identified for each facet of the consultation so that accurate information can be elicited in an efficient manner within a supportive patient-centred approach designed to facilitate patient engagement, thereby enhancing satisfaction and improving clinical outcomes. This is broadly consistent with the three core functions of the consultation: build a relationship, collect data and agree on a management plan .

Research into doctor–patient communication has established a number of key tasks of the consultation, including eliciting patients’ problems and concerns, giving information, discussing treatment options and being supportive . The key skills needed to perform these tasks have also been identified (see Box 2 ) . Unfortunately doctors often fail in these tasks. They fail to obtain sufficient information about patients’ perceptions or impact of the problem , they do not check how well the patient has understood and have a tendency to block disclosure of emotional cues .

Box 2. Skills doctors need to perform key tasks of the consultation

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