Do too many cooks spoil the broth? The effect of observers on doctor-patient interaction

Medical Education 2012: 46: 785794 Context The presence of additional medical personnel in consultations alters the focus of the doctorpatient interaction. Patients feel excluded from the interaction and relegated to the role of a non-person or prop, which leads to a loss of autonomy. Previous research has considered the psychological effects of the presence of additional persons on the interaction, but few studies have considered how these additional persons affect the performances of the consulting doctor and patient in the interaction. Methods A linguistic study drawing on the methods of discourse analysis was conducted to consider how the presence of additional medical personnel in the consultation alters doctors responses to patients questions, their management of patient-initiated topics, and their use of invitations to ask questions. Results When additional professionals were present in the consultation, the consultations were significantly longer than control group consultations (p = 0.04) and significantly more patient-initiated topics remained unresolved at the close of the consultation (p = 0.04). In consultations in which students were present, markedly fewer patient questions were answered than in control group consultations, and there was a notable reduction in the number of overt invitations to ask questions (both differences approached significance). There was, however, a significant reduction (p = 0.01) in the proportion of patient-initiated topics that were deferred when students were present in the consultation. Conclusions Previous research has identified a loss of patient focus when a patient sees doctors en masse. The results from the present study suggest that the presence of additional medical personnel can distract the focus of a consultation away from the patient, particularly when the additional participants are professionals rather than students. Further research is required to develop a greater understanding of multiple-doctorpatient interactions. A training programme should be developed to train consulting doctors at teaching hospitals to manage these multiple-doctorpatient consultations more effectively.