Patients' medical knowledge and health counseling: what kind of information helps to make communication patient-centered?

OBJECTIVE

To examine how physicians use information about a patient's background knowledge when both anticipating what a patient knows and producing actual answers in an email counseling setting.

METHODS

A fictitious patient used a (high vs. low) level of technical jargon in an email inquiry about diabetes and provided explicit information on prior knowledge (high vs. low) through self-report. Final-year medical students (semi-experts) were asked to gauge the patient's knowledge level (Experiment 1) and to produce an answer to the inquiry (Experiment 2). A total of N=150 participated in one of the two experiments.

RESULTS

Information from word usage and self-reports was used differently in the two experiments. A patient self-reporting low knowledge was assumed to have less background knowledge than one reporting some knowledge about the domain. The technicality of the patient's word use influenced the answers: these were more technical when the inquiry used technical jargon instead of everyday language.

CONCLUSION

Knowledge anticipation and communication behavior in email health care seem to be guided by different hints regarding the patient, suggesting the existence of two separate mechanisms.

PRACTICE IMPLICATIONS: Beyond merely teaching physicians or health care providers to be aware of the patient's knowledge level when formulating a patient-centered response, on-task methods should support health care providers during the actual communication phase by providing, for instance, metacognitive prompts.