How do patients experience consultations at an orthopaedic out-patient clinic? Eighteen patients comment on video-taped consultations: A qualitative study

The purpose of this study is to describe experiences of communication in medical consultations, obtained after patients have observed and commented on their own video recorded consultations. Eighteen patients in an orthopaedic out-patient clinic were randomly selected and, of these, 10 were men and 8 were women. Nine of the visits were first-time consultations and an equal number were follow ups. We explained that we wanted to understand what takes place between a doctor and patient, both when the experience is satisfactory and when it is not. Approximately 1 week after the consultation, the patient was allowed to watch the video recording. Prior to viewing this, the patient was instructed that we were particularly interested in his/her viewpoints and spontaneous reactions. Every time a patient wished to say something, the videotape was stopped and the comments recorded. These comments were later transcribed. The patients' negative comments (60%) described four kinds of experiences indicating aspects of poor communication: i) the patient had difficulty understanding what the physician asked, said or did, ii) the physician was insufficiently prepared for the consultation, iii) the physician questioned the findings of other doctors and iv) the physician showed a lack of understanding.