'Am I not talking to any medical doctors today?’ – Evaluation of effective and ineffective interactional practices in spinal pain clinic consultations

TY - JOUR

T1 - 'Am I not talking to any medical doctors today?’ – Evaluation of effective and ineffective interactional practices in spinal pain clinic consultations

AU - Emborg, Christina

AU - Rossen, Camilla Blach

AU - Hestbæk, Lise

PY - 2025/8

Y1 - 2025/8

N2 - Background: Evaluating communication in clinical settings is essential for enhancing patient satisfaction and improving treatment outcomes. Objective: This study examined the quality of consultations and communication practices used at a hospital-based Danish Medical Spine Clinic. Methods: Data included audio-taped consultations with patients suffering from low back pain and subsequent patient interviews. The methodological approach to analysing consultation recordings was Conversation Analysis, while interviews were openly coded and analysed thematically. By comparing the services delivered by the healthcare professionals and the patients' reflections, effective and less effective practices were identified. Results: The analyses showed that (1) diagnostic and prognostic information provided, partly based on MR imaging, was generally perceived as satisfactory by patients, and (2) treatment plans were meaningful to patients and developed through a collaborative process. Moreover, (3) healthcare professionals' communication was clear and displayed an orientation towards achieving mutual understanding with patients. Finally, (4) an initial outline of the consultation facilitated alignment of expectations. However, the analyses also demonstrated discrepancies between patient expectations and the actual consultation experience concerning (1) the occupational background of the clinician, (2) the purpose of the consultation, and (3) the kind of help offered by the clinic. These mismatches contributed to lower patient satisfaction and prompted negotiations around epistemic authority and legitimation of professional identity during consultations. Discussion: Improved alignment of patients' expectations could facilitate more effective consultations. Furthermore, despite the patients' satisfaction, the routine practice of explaining MR findings should be reconsidered based on recent evidence from prognostic research, which questions their relevance.

AB - Background: Evaluating communication in clinical settings is essential for enhancing patient satisfaction and improving treatment outcomes. Objective: This study examined the quality of consultations and communication practices used at a hospital-based Danish Medical Spine Clinic. Methods: Data included audio-taped consultations with patients suffering from low back pain and subsequent patient interviews. The methodological approach to analysing consultation recordings was Conversation Analysis, while interviews were openly coded and analysed thematically. By comparing the services delivered by the healthcare professionals and the patients' reflections, effective and less effective practices were identified. Results: The analyses showed that (1) diagnostic and prognostic information provided, partly based on MR imaging, was generally perceived as satisfactory by patients, and (2) treatment plans were meaningful to patients and developed through a collaborative process. Moreover, (3) healthcare professionals' communication was clear and displayed an orientation towards achieving mutual understanding with patients. Finally, (4) an initial outline of the consultation facilitated alignment of expectations. However, the analyses also demonstrated discrepancies between patient expectations and the actual consultation experience concerning (1) the occupational background of the clinician, (2) the purpose of the consultation, and (3) the kind of help offered by the clinic. These mismatches contributed to lower patient satisfaction and prompted negotiations around epistemic authority and legitimation of professional identity during consultations. Discussion: Improved alignment of patients' expectations could facilitate more effective consultations. Furthermore, despite the patients' satisfaction, the routine practice of explaining MR findings should be reconsidered based on recent evidence from prognostic research, which questions their relevance.

KW - communication

KW - consultation practices

KW - doctor-patient interaction

KW - expectations

KW - health care delivery

KW - low back pain

KW - qualitative research

UR - https://www.scopus.com/pages/publications/105010648995

U2 - 10.1111/jep.70134

DO - 10.1111/jep.70134

M3 - Journal article

C2 - 40652549

SN - 1356-1294

VL - 31

JO - Journal of Evaluation in Clinical Practice

JF - Journal of Evaluation in Clinical Practice

IS - 5

M1 - e70134

ER -