title: Chest pain: communication of symptoms and history in a London emergency department.
abstract: OBJECTIVE
  To describe patient-provider interactions for patients in an emergency department with possible acute coronary syndrome (ACS) and to generate hypotheses about how communication might contribute to sociocultural disparities in cardiac care.
  
  
  METHODS
  Qualitative analysis of observational data. Seventy-four consecutive patients presenting between 8 a.m. and 10 p.m. over a 4-month period.
  
  
  RESULTS
  Participants were aged 40-85 years; 58% were male; 67% were white, 18% Afro-Caribbean, and 15% South East Asian. Observations revealed significant obstacles to communication for the majority of patients. The three most prominent impediments to effective communication were: the use of leading questions to define chest pain, patient-provider conflict as a result of, and contributor to, poor communication, and frank miscommunication due to language barriers and translational difficulties.
  
  
  CONCLUSIONS
  This study documents aspects of the communication process that compromise the quality of the medical history obtained in emergency department patients with suspected ACS. Accurate diagnosis relies on an interaction that weaves both the patient's and the physician's perspective into a shared understanding of events that comprise a patient's history. When diagnostic short cuts are taken to overcome educational, cultural, or language barriers in the medical interview, they may contribute to health care disparities.
  
  
  CONCLUSIONS
  Physicians should take a more attentive and careful approach to patient interviewing than was observed here and should be aware of the ways in which they shape the interview through their questions and focus. Good communication skills can be effectively taught at all levels of training and practice.
authors.affiliation: University of Pennsylvania School of Medicine, Department of Internal Medicine, 100 Centrex, 3400 Spruce Street, Philadelphia, PA 19104, USA. Steven.Farmer@aya.yale.edu
authors.forename: Steven A
authors.initials: SA
authors.lastname: Farmer
authors.forename: Debra L
authors.initials: DL
authors.lastname: Roter
authors.forename: Irene J
authors.initials: IJ
authors.lastname: Higginson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001294:Attitude to Health; D002637:Chest Pain / Q000209:etiology; D002983:Clinical Competence / Q000592:standards; D003144:Communication Barriers; D003327:Coronary Disease / Q000150:complications / Q000175:diagnosis / Q000523:psychology*; D004636:Emergency Service, Hospital; D004638:Emergency Treatment / Q000379:methods / Q000523:psychology; D004641:Emigration and Immigration; D005260:Female; D006785:Hospitals, University; D006801:Humans; D008131:London; D008297:Male; D008487:Medical History Taking / Q000379:methods; D008505:Medical Staff, Hospital / Q000193:education / Q000523:psychology*; D008875:Middle Aged; D019303:Multilingualism; D010817:Physician-Patient Relations; D011204:Poverty Areas; D036301:Qualitative Research; D011795:Surveys and Questionnaires