title: Explanations in consultations: the combined effectiveness of doctors' and nurses' communication with patients.
abstract: BACKGROUND
  Multidisciplinary and interprofessional working is currently a priority in health care policy, in caring for patients and in health professional education. Realising multidisciplinary approaches presents challenges in the context of changes in doctors' and nurses' roles and the increased emphasis placed on communication with patients. In communication in consultations, explanations are employed in the service of numerous activities, including decision making, diagnosis and physical examination, but they have been little studied.
  
  
  METHODS
  This paper presents findings from a comparative study of doctors' and nurses' communication with patients in multidisciplinary health care, focusing on diabetes in primary care.
  
  
  METHODS
  Video- and audio-recorded consultations were subjected to conversation analysis. Output from discussion groups with patient representatives and health professionals underwent qualitative analysis.
  
  
  RESULTS
  Distinctive features of explanations in nurses' and doctors' consultations with patients were identified. These can be understood by reference to patterns of communication. Nurses' communication was mediated by patients' contributions; doctors' communication gave an overarching direction to the consultation as a whole. While nurses' explanations began from the viewpoint of a patient's responsibility and behaviour, doctors' explanations began from the viewpoint of biomedical intervention. Their consultations lent different opportunities for patients' involvement.
  
  
  CONCLUSIONS
  Nurses' and doctors' communications each exhibit their own distinct features. Specification of these features, when considered in the context of a particular consultation activity such as explanations, allows both recognition of the distinct contributions each profession can offer and identification of ways of combining these to maximum effect. This has implications for policy, for practice and for interprofessional education.
authors.affiliation: Department of Health Sciences and Hull/York Medical School, University of York, York, UK. sfc1@york.ac.uk
authors.forename: Sarah
authors.initials: S
authors.lastname: Collins
mesh_terms: D001786:Blood Glucose; D002983:Clinical Competence / Q000592:standards*; D003142:Communication; D003920:Diabetes Mellitus / Q000451:nursing; D004739:England; D005194:Family Practice / Q000592:standards*; D005260:Female; D006801:Humans; D008297:Male; D009723:Nurse-Patient Relations; D010817:Physician-Patient Relations
chemical_list: D001786:Blood Glucose