title: A brief conversation analytic communication intervention can change history-taking in the seizure clinic.
abstract: Question design during history-taking has clear implications for patients' ability to share their concerns in general and their seizure experiences in particular. Studies have shown that unusually open questions at the start of the consultation enable patients to display interactional and linguistic markers which may help with the otherwise challenging differentiation of epileptic from nonepileptic seizures (NES). In this study, we compared the problem presentation approach taken by trainee neurologists in outpatient encounters with new patients before and after a one-day conversation analytic training intervention in which doctors were taught to adopt an open format of question design and recognize diagnostically relevant linguistic features. We audio/video-recorded clinical encounters between ten doctors, their patients, and accompanying persons; transcribed the interactions; and carried out quantitative and qualitative analyses. We studied 39 encounters before and 55 after the intervention. Following the intervention, doctors were significantly more likely to use nondirective approaches to soliciting patient accounts of their presenting complaints that invited the patient to describe their problems from their own point of view and gave them better opportunity to determine the initial agenda of the encounter. The time to first interruption by the doctor increased (from 52 to 116 s, p<.001). While patients were given more time to describe their seizure experiences, the overall appointment length did not increase significantly (19 vs 21 min, n.s.). These changes gave patients more conversational space to express their concerns and, potentially, to demonstrate the interactional and linguistic features previously found to help differentiate between epilepsy and NES, without impacting the length of the consultations.
authors.affiliation: Academic Neurology Unit, University of Sheffield, Sheffield, UK. Electronic address: Laura.Jenkins@nottingham.ac.uk.
authors.forename: Laura
authors.initials: L
authors.lastname: Jenkins
authors.affiliation: Department of Neurology, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, UK.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Cosgrove
authors.affiliation: Academic Neurology Unit, University of Sheffield, Sheffield, UK.
authors.forename: Katie
authors.initials: K
authors.lastname: Ekberg
authors.affiliation: Royal Hallamshire Hospital, Glossop Road, Sheffield, UK.
authors.forename: Ammar
authors.initials: A
authors.lastname: Kheder
authors.affiliation: Royal Hallamshire Hospital, Glossop Road, Sheffield, UK.
authors.forename: Dilraj
authors.initials: D
authors.lastname: Sokhi
authors.affiliation: Academic Neurology Unit, University of Sheffield, Sheffield, UK.
authors.forename: Markus
authors.initials: M
authors.lastname: Reuber
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003142:Communication; D003937:Diagnosis, Differential; D004827:Epilepsy / Q000175:diagnosis / Q000523:psychology; D005260:Female; D006801:Humans; D007406:Interview, Psychological; D008297:Male; D008487:Medical History Taking / Q000379:methods*; D008875:Middle Aged; D010817:Physician-Patient Relations; D012640:Seizures / Q000175:diagnosis* / Q000523:psychology; D055815:Young Adult
keywords: Conversation analysis; Doctor–patient communication; Epilepsy; Intervention; Nonepileptic seizures