Patient centredness

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92 HEALTH PSYCHOLOGY
no good or not being needed (personal probability of benefit). Therefore, although the
actual risk of the treatment was the same in all four conditions, the ways of presenting
this risk varied and this resulted in a variation in patient uptake. Harris and Smith (2004)
carried out a similar study but compared absolute risk (high vs low risk) with comparative
risk (above average vs below average). They asked participants to read information about
deep vein thrombosis (DVT) and to rate a range of beliefs. Participants were then told to
imagine their risk of DVT in either absolute or comparative terms. The results showed
that the US sample were more disturbed by absolute risk. However, doctors not only have
beliefs about risk but also about illness which could be communicated to patients. Ogden
et al. (2003) used an experimental design to explore the impact of type of diagnosis on
patients’ beliefs about common problems. Patients were asked to read a vignette in
which a person was told either that they had a problem using a medical diagnostic term
(tonsillitis/gastroenteritis) or using a lay term (sore throat/stomach upset). The results
showed that although doctors are often being told to use lay language when speaking to
patients, patients actually preferred the medical labels as it made the symptoms seem
more legitimate and gave the patient more confidence in the doctor. In contrast the lay
terms made the patients feel more to blame for the problem. Therefore, if a doctor holds
particular beliefs about risk or the nature of an illness, and choses language that reflects
these beliefs, then these beliefs may be communicated to the patient in a way that may
then influence the patient’s own beliefs and their subsequent behaviour.
Explaining variability – an interaction between health
professional and patient
The explanations of variability in health professionals’ behaviour presented so far have
focused on the health professional in isolation. The educational model emphasizes
the knowledge of the health professional and ignores the factors involved in the clinical
decision-making process and their health beliefs. This perspective accepts the traditional
divide between lay beliefs and professional beliefs. Emphasizing the clinical decisionmaking processes and health beliefs represents a shift from this perspective and attempts
to see the divide between these two types of belief as problematic; health professionals
have their own individualized ‘lay beliefs’ similar to patients. However, this explanation
of variability ignores another important factor, namely the patient. Any variability
in health professionals’ behaviour exists in the context of both the health professional
and the patient. Therefore, in order to understand the processes involved in health
professional–patient communication, the resulting management decisions and any
variability in the outcome of the consultation, both the patient and health professional
should be considered as a dyad. The consultation involves two individuals and a communication process that exists between these individuals. This shift from an expert model
towards an interaction is reflected in the emphasis on patient centredness.
Patient centredness
First developed by Byrne and Long in 1976 the concept of patient centredness
has become increasingly in vogue over recent years. The prescriptive literature has
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