Beyond content analysis and non-verbal behaviour - what about atmosphere? A phenomenological approach.
OBJECTIVE
Basic research and careful observation of clinical practice have yielded a vast amount of empirical data on communication in health care. This research has been guided by the assumption that good communication will be better understood and easier to teach when its single constituents are identified. This paper points to the limitation of this approach.


METHODS
Based upon the terminology of phenomenological thinking grounded in neo-phenomenology (Hermann Schmitz) contradictory findings from the literature on patient-centred communication in Internal Medicine and Oncology are used as a starting point to elucidate different paradigms in conducting research in clinical communication.


RESULTS
The phenomenological approach of the German philosopher Hermann Schmitz (*1928) is briefly presented. It is based upon experiences that 'on the average everybody can vividly access or retrieve from his memory'. Empirical research does not provide unequivocal advice how to communicate with an individual patient. Likewise, researchers note unexpected reactions from real patients-they do not behave as the expert would assume. The inclusion of the phenomenon of a certain atmosphere is proposed referring to the impression of 'something in the air' that sometimes can be identified during communication or upon entering a room. Even though it can be sensed with high evidence, it cannot be deduced from particular observations. Instead, the atmosphere is part of a situation in which meaning is dissolved in chaotic manifoldness. Sensing an atmosphere is a function of the lived body (Leib) as opposed to phenomena that are mediated by the senses.


CONCLUSIONS
Current research and teaching models cover only part of the phenomenology of professional communication. How research and education might profit from the addition of Schmitz' philosophical approach will be outlined in this article.


CONCLUSIONS
Including perceptions of the lived body (Leib) should improve research in clinical communication and teaching courses.
Langewitz
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Division of Psychosomatic Medicine/Internal Medicine, University Hospital Basel, Hebelstr. 2, CH-4031 Basel, Switzerland. wlangewitz@uhbs.ch
D001291:Attitude of Health Personnel; D001294:Attitude to Health; D002983:Clinical Competence; D003299:Cooperative Behavior; D003479:Curriculum; D004645:Empathy; D005863:Gestalt Theory; D006301:Health Services Needs and Demand; D006801:Humans; D007388:Internal Medicine / Q000458:organization & administration; D008495:Medical Oncology / Q000458:organization & administration; D008884:Milieu Therapy; D009633:Nonverbal Communication / Q000523:psychology*; D018802:Patient-Centered Care / Q000458:organization & administration; D010686:Philosophy, Medical; D010817:Physician-Patient Relations; D033302:Postmodernism; D036301:Qualitative Research; D012107:Research Design; D012660:Semantics; D012944:Social Support