WHERE’S THE PATIENT? PATIENT-CENTERED TALK IN REFERRAL AND CONSULTANT LETTERS

Title WHERE’S THE PATIENT? PATIENT-CENTERED TALK IN REFERRAL AND CONSULTANT LETTERS
Author, Co-Author Marlee Spafford, Catherine Schryer, Lorelei Lingard, Jenna Hildebrand
Topic
Year
2006
Day
Program Number
065106
Room
Affiliation
University of Waterloo, School of Optometry and Vision Science
Abstract PURPOSE: A cornerstone of patient-centered (PC) care is patient voice—evident through the incorporation of patients’ illness experiences, agendas, and input in treatment decisions. PC care has focused on practitioners’ talk with but not about patients. We wondered whether a PC agenda would extend to practitioners’ talk about patients in referral and consultant letters. Biomedical professional socialization may account, in part, for the limited attention to patient perspective in medical referral and consultation letters. Studies of interdisciplinary letters involving optometrists and ophthalmologists are rare and have not considered patient voice.

METHODS: Seventy-four letters (37 optometrist referrals and the corresponding ophthalmologist consultations) were analyzed by frequency for discursive features of patient voice. Eight 4th-year optometry students and 6 optometrist instructors in an optometry teaching clinic plus 3 community ophthalmologists were interviewed about their letter writing strategies. Interview data were analyzed using a grounded theory approach.

RESULTS: A minority (~1/3) of the letters included patient voice—mostly displayed as patient ‘complaints’. Interview participants agreed that optometry and ophthalmology letters displayed little evidence of patient voice although they varied in their interpretation of what constituted patient voice. The need to include patient voice in letters was seen as an exception when patient agendas were unique or unexpected. Participants did not perceive any problems with the lack of patient voice in these letters.

CONCLUSIONS: There were limited discursive displays of patient voice in 74 optometrist referral and ophthalmologist consultation letters. We postulate that biomedical professional socialization, reflected in optometry-ophthalmology talk about patients, may hinder attempts to engage in PC talk with patients and we reflect on the impact of this tension on optometry novices.

ADDITIONAL COMMENTS: This study was funded by the Social Sciences & Humanities Research Council (SSHRC), Grant #410-04-2139.
Affiliation of Co-Authors University of Waterloo, School of Optometry and Vision Science, University of Toronto, University of Waterloo, School of Optometry and Vision Science
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