Eyeworld

O phthalmologists have a lot of power in their clin- ics, not only in the treat- ment they provide, but also in the manner in which they communicate with pa- tients. In fact, communicating effec- tively leads to improved treatment, according to research. "Our observations showed that effective clinician communication had a salutary effect on the patient's mental state during the interaction, and helped the patient understand that self-care is equally important in the treatment of chronic disease," reported lead study author Shobha Mocherla, Central Audio-Visual Unit, L.V. Prasad Eye Institute, Hyderabad, India. "Communication might enable patients of such chronic conditions to understand that although they cannot hope for a cure, participation in the treat- ment regimen can help halt any de- terioration." The study, published online in November 2010 in Qualitative Health Research, analyzed the power of communication between physicians and patients and found room for im- provement. "We found that clinicians en- force their 'disciplining power' through varying degrees of commu- nicativeness to bring about compli- ance in the patient," Ms. Mocherla reported. "Clinicians appear to clas- sify the patient as 'participant' or 'deviant' based on the patient's 'in- ternalization' of instructions, and then communicate in predictable ways with the patient. Patients can also wield power, communicating it by understanding and following or not understanding and not clarify- ing/verifying instructions in the clinic, and thereafter failing to com- ply with the clinician's advice. We suggest that clinicians need to hone their communication skills both to optimally utilize interactions in the clinic and to encourage patient com- pliance, thereby making possible better treatment outcomes." Toward better communication The researchers analyzed clinical in- teractions in an outpatient glau- coma clinic in southern India. Clinicians involved included five consultant ophthalmologists who were glaucoma specialists and 10 op- tometrists. "The first author entered one of the rooms in the clinic at random on different days and at different times, and stood to the side during the consultation, making notes in a diary of the observation number, room number, time of observation, clinicians names (if known), and se- quence of events in the observed in- teractions, including all verbal and nonverbal dialogue between partici- pants in the room," Ms. Mocherla reported. "Applying elements of the French philosopher Michel Foucault's concept of power and knowledge, we deconstructed the structuring and moderating influ- ences on the expert/non-expert dyad." Clinical communication fol- lowed some interesting patterns. "In our observations of clinician–patient interactions, we found that when clinicians could not communicate with the patient (in the same lan- guage or using a translator, giving instructions at the patient's pace, using simple words), then the pa- tient either sought additional clarifi- cations or remained silent," Ms. Mocherla reported. "A patient's si- lence was accompanied by him or her looking away or exchanging glances with the attendant. Few pa- tients made any attempt to clarify their doubts." Physicians nonetheless have many communication advantages at their disposal. "Clinicians wield dis- ciplining power through a control- ling hierarchical gaze consisting of biomedical scrutiny, expressed in- structions, and a prescription," Ms. Mocherla noted. "The patient assim- ilates the instructions and responds through a reciprocal hierarchical gaze consisting of watchful observa- tion of clinicians and responsiveness to instructions. The subsequent posi- tive outcome of the intersection of March 2011 by Matt Young EyeWorld Contributing Editor Effective communication can improve treatment outcomes 672062PI_2_23x12_5.pgs - Thu Feb 10 11:21:06 PST 2011

• Cover