The Patient Practitioner Relationship

Health psychology starts from a simple, evidenced claim: how a practitioner and patient communicate changes health outcomes.

Why it matters. Effective communication:

• improves diagnosis (the patient discloses the right information),
• increases adherence to treatment (see [[adherence-to-medical-advice]]),
• raises satisfaction and trust, and
• can reduce anxiety and even improve recovery. Poor communication causes misdiagnosis, non-adherence, complaints and worse outcomes.

A two-way relationship. Communication is bidirectional — it depends on the practitioner (their skills and style) and the patient (their ability/willingness to disclose, understand and recall). Both sides have skills and barriers.

The recall problem. Patients forget a large share of what they are told in a consultation — often the diagnosis is remembered but the instructions are not. This is a key reason communication must be clear and checked.

Why this matters for the exam. Hold the idea that communication is a two-way process affecting outcomes: it lets you explain why practitioner skills, consulting style and patient factors all matter, and why improving communication is worth studying.

Practitioners need strong interpersonal skills, both verbal and non-verbal.

Verbal skills:

• Open questions to encourage disclosure ('tell me about…') vs closed ones for specifics.
• Active listening, summarising and not interrupting.
• Clear, jargon-free language matched to the patient.
• Showing empathy and reassurance.

Non-verbal skills (often more powerful):

• Eye contact, open posture, leaning in, nodding (attention/warmth).
• Tone of voice, facial expression and appropriate touch.
• Reading the patient's non-verbal cues (anxiety, confusion).

Effect. Good interpersonal skills build rapport and trust, encouraging the patient to disclose symptoms honestly and to understand and follow advice.

Evaluation in brief. Communication skills are trainable and have clear application, but much evidence is correlational (good communicators may differ in other ways), self-reported satisfaction is subjective, and the 'best' skills depend on the patient and culture.

Two consulting styles:

• Doctor-centred (directing) — the doctor leads: closed questions, focuses on the medical problem, gives instructions, little patient input. Efficient and good for clear acute problems, but can feel impersonal and reduce disclosure.
• Patient-centred (sharing) — the doctor shares control: open questions, explores the patient's ideas, concerns and expectations, involves them in decisions. Builds rapport and suits chronic/complex or emotional issues, but takes more time.

Savage & Armstrong (1990). In a GP study comparing a directing style ('this is what is wrong, this is what to do') with a sharing style ('what do you think is wrong?'), many patients — especially with physical problems — reported high satisfaction with the directing style. The lesson is not that one style is always best, but that the style should fit the patient and the problem.

Evaluation in brief. This research is applicable to training and uses real consultations (ecological validity), but satisfaction is self-reported/subjective, results may not generalise across cultures or problem types, and the 'best' style is individual.

Patients can misuse health services in opposite directions — using them too much or too little.

Over-use:

• Hypochondriasis (illness anxiety) — persistent, excessive worry about having a serious illness, with frequent checking and reassurance-seeking, despite medical reassurance.
• Munchausen syndrome (factitious disorder) — deliberately faking or inducing illness to gain the 'sick role' (attention/care), not for external reward (which would be malingering). 'Munchausen by proxy' involves inducing illness in another (e.g. a child).

Under-use:

• Delay in seeking treatment — putting off going to the doctor. Stages of delay include appraisal delay (deciding a symptom is serious), illness delay (deciding to seek care) and utilisation delay (actually attending). Causes include fear, denial, cost, embarrassment, and misreading symptoms — and delay can be dangerous (e.g. with cancer or heart attack).

Evaluation in brief. These concepts are clinically important and well-described, but are hard to measure objectively (internal states/motives), overlap with other disorders, and are shaped by culture and access to care.

Improving communication:

• Communication-skills training for practitioners (questioning, listening, empathy).
• Plain language and avoiding jargon; using written/visual information.
• Checking understanding (e.g. asking the patient to repeat back the plan — 'teach-back').
• Chunking and ordering information, and stressing the most important points (helps recall).
• Building rapport and allowing the patient to ask questions.

Pulling it together for Paper 3 'evaluate / discuss':

Strengths

• Strong real-world application — training, consultation design, better adherence/outcomes.
• Often studied in real consultations (ecological validity).

Weaknesses / issues

• Subjective measures — satisfaction and understanding are self-reported.
• Correlational evidence — hard to prove communication causes better outcomes.
• Individual & cultural differences in preferred style and communication norms.

Relevant issues & debates

• Application to everyday life (the central strength); individual vs situational; idiographic vs nomothetic (one style for all vs tailoring); use of quantitative vs qualitative data.