Paper Title: Communicative Practices Clinicians Use to Correct Patient Misconceptions in Primary Care Visits

Author(s) and Year: Jennifer Gerwing, Anne E. C. White, and Stephen G. Henry; 2023

Journal: Health Communication (closed access)

Misconceptions held by patients about health issues can alter patients’ expectations, decrease their satisfaction with their care, and negatively affect their relationships with clinicians. So it comes as no surprise that clinicians want to employ the most optimal and empathetic ways to address misconceptions. Examining patient misconceptions and how to correct them in an effective way can help healthcare providers move toward successful patient-centered care practices, promote patient safety, and improve clinical outcomes. An informed patient makes better decisions regarding their health! Gerwing et al. sought to study and analyze the real-time corrections used by clinicians.

The Background

Why Should These Misconceptions Be Corrected?

Early research on patient-clinician communication in the 1960s demonstrated that clinicians tended to correct their patients on technical concepts, like medical terms or jargon, instead of understanding and listening to patient concerns. This could make patients feel defensive and dissatisfied with their care, leading them to discount new information, stop listening, or exhibit “token agreement” (i.e., agreeing in the moment, but not internalizing the correction). These interactions can affect a patient’s view of themself as self-sufficient and autonomous, which in turn does not elicit positive behavioral changes.

Despite existing research on clinicians’ corrections of patients, the authors contend that there is little known regarding how clinicians correct patient misconceptions during “authentic” clinical interactions. Gerwing et al. posed the following questions:

1. How commonly are patient misconceptions corrected by clinicians?
2. What clinical topics do patients hold misconceptions about?
3. Do corrected misconceptions have implications for the patient’s future behavior?
4. What communicative practices are used by clinicians during corrections?

The Methods

To address their research questions, the authors recorded primary care visits and then analyzed the interactions and conversations between the clinicians and the patients. Eligible participants were English-speaking adults prescribed opioids for chronic pain. The study’s three authors have a wide range of experience in clinical interactions and conversation analysis, as well as clinical expertise. This background allowed them to analyze the form and timing of the conversations, as well as linguistic variables such as speech, overlap, pauses, and intonation.

Gerwing et al. classified the misconceptions by topic and the communicative practices the clinicians used to address them. Also, the authors determined if the corrections had implications for the patients’ future behavior.

The Results

In the study, 23 primary care visits were recorded and analyzed. In all these visits, 59 “patient misconception-clinician correction” episodes were identified, for an average of two corrections per visit. Misconceptions related to medications were the most common clinical topic discussed during patient visits. Forty one percent of corrections had implications for the patients’ future behavior; however, these implications weren’t analyzed in this study.

The practices used by clinicians to correct misconceptions were categorized as direct and indirect. Direct practices consisted of an explicit correction of the patient’s error, and included: 1) displaying surprise; 2) marking correction with disagreement; and 3) contradicting a patient’s incorrect statement. Practices were categorized as indirect when correct information was transmitted without an explicit address of the patient’s error. They consisted of: 1) presenting a correct proposition; 2) providing an explanation; 3) invoking an outside authority; and 4) demonstrating or showing evidence for the patient to observe.

When clinicians corrected pain-related misconceptions, they were more likely to use indirect practices. The authors hypothesize that this is because the topic of chronic pain, especially when considering the stigma related to opioid usage, is a difficult one to broach, and can be frustrating for both patients and clinicians. Indirect practices might be a way for clinicians to avoid conflict and de-escalate difficult conversations.

The Impact

Limitations to Consider

Before concluding this Bite, it is important to address the limitations of the study. The recorded interactions occurred only at primary care visits addressing chronic pain. This lessens how much the results can be generalized, as there might be different results when visits with a specialist are studied, for example. Another limitation is that the clinicians in these visits were second- and third-year residents, and therefore still in training. It would have been interesting to observe how doctors with a range of experience (e.g., from interns to attendings) address and correct patient misconceptions. 

Lastly, non-English speaking patients were excluded from the study. I believe it is important for future research to include this patient population, due to cultural differences in how they experience care and their attitudes toward clinicians. Because of this, I am interested to know the race and ethnicity breakdown of the study participants, as this could have affected the results.

A proposed research question of Gerwing et al.’s that was not discussed was how corrected misconceptions may affect patients’ future behaviors. This is due to the fact that their study did not evaluate or collect long-term, follow-up data to determine this. This merits future research so that a relationship between certain communicative practices and their effects on patient behavior can be established.

Mind the (Knowledge) Gap

A patient’s healthcare needs cannot be fully met if there are misunderstandings between them and their providers. Because of this, it is of utmost importance that the methods used to correct misconceptions in patients be studied. This will allow for a better understanding of which practices yield the best results and behavioral changes.

“This more empathetic approach could help patients to perceive these moments of interaction as an extension of their clinician’s care rather than as a display of clinical expertise.”

Most importantly, the authors argue that clinicians must do the “interactional work” of meeting patients at their level and asking about their ideas, so that the correct information can be presented in a way that best suits the patient. In other words, understanding how or why misconceptions have come about is key to knowing what information will be meaningful to the patient.

Avoiding pedantry, establishing common ground, and understanding the why behind patients’ misconceptions are key in engaging with patients empathetically and fostering better health outcomes. The further study of corrective methods and their effectiveness in bettering patient care is still needed. The information gleaned from this can help science communicators in healthcare to better engage, educate, and empower patients.

Written by Mariella A. Mestres-Villanueva

Edited by Mykyta ‘Nik’ Kliapets and Madeline Fisher

Featured image credit: Hasan As Ari (Vecteezy)