title: Verbal and non-verbal behavior of doctors and patients in primary care consultations - how this relates to patient enablement.
abstract: OBJECTIVE
  To assess the relationship between observable patient and doctor verbal and non-verbal behaviors and the degree of enablement in consultations according to the Patient Enablement Instrument (PEI) (a patient-reported consultation outcome measure).
  
  
  METHODS
  We analyzed 88 recorded routine primary care consultations. Verbal and non-verbal communications were analyzed using the Roter Interaction Analysis System (RIAS) and the Medical Interaction Process System, respectively. Consultations were categorized as patient- or doctor-centered and by whether the patient or doctor was verbally dominant using the RIAS categorizations.
  
  
  RESULTS
  Consultations that were regarded as patient-centered or verbally dominated by the patient on RIAS coding were considered enabling. Socio-emotional interchange (agreements, approvals, laughter, legitimization) was associated with enablement. These features, together with task-related behavior explain up to 33% of the variance of enablement, leaving 67% unexplained. Thus, enablement appears to include aspects beyond those expressed as observable behavior.
  
  
  CONCLUSIONS
  For enablement consultations should be patient-centered and doctors should facilitate socio-emotional interchange. Observable behavior included in communication skills training probably contributes to only about a third of the factors that engender enablement in consultations.
  
  
  CONCLUSIONS
  To support patient enablement in consultations, clinicians should focus on agreements, approvals and legitimization whilst attending to patient agendas.
authors.affiliation: Warwick Medical School, The University of Warwick, UK. Teresa.Pawlikowska@warwick.ac.uk
authors.forename: Teresa
authors.initials: T
authors.lastname: Pawlikowska
authors.forename: Wenjuan
authors.initials: W
authors.lastname: Zhang
authors.forename: Frances
authors.initials: F
authors.lastname: Griffiths
authors.forename: Jan
authors.initials: J
authors.lastname: van Dalen
authors.forename: Cees
authors.initials: C
authors.lastname: van der Vleuten
mesh_terms: D000328:Adult; D003142:Communication; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D007697:Kinesics; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008960:Models, Psychological; D018802:Patient-Centered Care; D026684:Personal Autonomy; D010817:Physician-Patient Relations; D011209:Power, Psychological; D011320:Primary Health Care / Q000379:methods*; D011594:Psychometrics; D036301:Qualitative Research; D012017:Referral and Consultation; D014705:Verbal Behavior