This article was written by Mathilde Jansen and previously appeared on Nemo Kennislink. Photo: Pexels
A stomachache, a headache or backpain. These are physical complaints that we all experience now and again. But there is a group of patients who continually suffer from such pains without a clear explanation. General practitioners often feel powerless when dealing with this group of patients, and that is reflected in their use of language. They often use negative phrases and expressions of uncertainty, as shown in recent research done by Inge Stortenbeker of the Language and Communication Science faculty at Radboud University.
This is an important finding, because it is precisely with this group that the manner of communicating can make a large difference, said the researcher. “Doctors are trained to perform physical examinations and recognise illnesses. But with this group, they don’t always find underlying illnesses. Communication then plays an important role. On the one hand by the patient: how can you describe your symptoms; but also by the doctor: how do you discuss symptoms that can’t be explained?”
Preconceptions
The researcher analysed 82 conversations between general practitioners and patients. Half of these patients had persistent physical symptoms. Stortenbeker studied the language use of both the doctors and the patients. “There are considerable preconceptions about this group, for example that they would exaggerate their pain or use vague wordings. This is why we measured language intensity and language abstraction, for example. We found no differences in this between the two groups. Language intensity (‘I suffer a lot from it’) was seen among all patients. It’s the patient’s way of showing that he or she is attending the doctor’s office with a valid reason and with symptoms that are doctorable.”
But she did find a difference in the language used by general practitioners, especially the fact that they used positive language less frequently. “You can say ‘the lungs sound clean’ or ‘I don’t hear anything strange’. The message is the same, but the first formulation is positive and the second negative. General practitioners used such negative formulations more often with people with persistent symptoms whereas, in the case of patients with medically explained symptoms, they softened the impact of their message by saying, for example, ‘I don’t have good news’ rather than ‘I have bad news’.”
The researcher has a clear explanation for the difference in language use. “In the case of a patient with persistent symptoms, the doctor is primarily interested in ruling out illnesses. So you listen to the lungs (‘no, I don’t hear anything strange’), you examine the stomach (‘no irregularities’), etc. It’s a logical pattern that a doctor should be made aware of. Turn it around: formulate the message so that it sounds good, that everything is normal rather than ruling out everything that it isn’t.”
Patients less anxious
Experimental research often involving fictional conversations had previously found that positive language use can indeed alleviate patients’ anxiety symptoms. Stortenbeker’s research also showed this, but then in actual conversations. Prior to and following a consultation, patients were given a questionnaire about how anxious they were at that moment. In conversations in which the general practitioner used more positive language, patients felt less anxious after the consultation than they did before.
Just as previous studies showed, this illustrates how important a general practitioner’s language use is. It’s not without reason that attention is given to communication techniques in general practitioner training. Stortenbeker refers to the general practitioner as the ‘superspecialist’ with respect to communication. But she thinks that there should still be more awareness of ‘positive language’.
GP Rob van der Spruit can relate to that. He has been working in the same general practice for over 11 years and says that he’s very conscious of his communication. He adjusts this to the person sitting opposite him. Just like every GP, he frequently sees patients with persistent symptoms. And he realises that he’s then in a different ‘communication mode’. “If a patient often returns with the same complaints, I think that he or she is still worried. So I tend to try to exclude even more illnesses. So I could certainly use phrases like ‘I don’t hear anything strange’. I could be more aware of this.”
No tumour, doctor?
The right communication tool is essential for Van der Spruit in order to practice his profession well. “I’m aware of the words I choose and I sometimes also use visual aids. But I always try to see if the patient has understood what I’ve said. I do this with both highly educated patients and patients with lower? education because all of them are patients: they have worries and fears, which could make it difficult for them to process or remember information.”
According to Van der Spruit, the most important factor in the communication between doctor and patient is clarifying the reason for their visit. “The exact complaint isn’t that interesting to me as a general practitioner. What I especially want to know is why this person is coming to me now with this complaint. It’s not always easy to ascertain the reason for their visit. An often-repeated anecdote is the one about the patient who comes to the doctor with an earache. After the doctor has examined the ear, he concludes that there’s an ear infection and he prescribes acid droplets. The patient then starts to leave and, with his hand on the door handle, says: ‘So it isn’t a tumour, doctor?’ I once experienced this myself and I thought: shit, so that was really the question, but I didn’t realise it.”
Toolkit
“Actually, I think that this aspect of communicating with patients with persistent symptoms can also be traced back to the request for help,” said Van der Spruit. “When patients return for the umpteenth time, I tend to think that they’re coming with the same problem and I continue to try to eliminate illnesses. You could also say: I see that you’re worried and what are you worried about? People might then say: I’m actually worried that I have a tumour. Then you should refer them further, for example, and take other steps.”
Stortenbeker is currently developing a toolkit to help general practitioners further refine their communication techniques. “You should consider this as a toolkit in which you can find various communication tools,” she explained. “Sometimes that’s a positive formulation, but a negative formulation isn’t always wrong. Doctors can sense for themselves which tool to use when. So that’s what we’re working on, trying to further expand the perspective of general practitioners.”