title: Limits of 'patient-centredness': valuing contextually specific communication patterns.
abstract: BACKGROUND
  Globally, doctor-patient communication is becoming synonymous with high-quality health care in the 21st century. However, what is meant by 'good communication' and whether there is consensus internationally remain unclear.
  
  
  OBJECTIVE
  Here, we characterise understandings of 'good communication' in future doctors from medical schools in three contextually contrasting continents. Given locally specific socio-cultural influences, we hypothesised that there would be a lack of global consensus on what constitutes 'good communication'.
  
  
  METHODS
  A standardised two-phase methodology was applied in turn to each of three medical schools in the UK, Egypt and India (n = 107 subjects), respectively, in which students were asked: 'What is good communication?' Phase I involved exploratory focus groups to define preliminary themes (mean number of participants per site: 17). Phase II involved thematic confirmation and expansion in one-to-one semi-structured interviews (mean number of participants per site: 18; mean hours of dialogue captured per site: 55). Findings were triangulated and analysed using grounded theory.
  
  
  RESULTS
  The overarching theme that emerged from medical students was that 'good communication' requires adherence to certain 'rules of communication'. A shared rule that doctors must communicate effectively despite perceived disempowerment emerged across all sites. However, contradictory culturally specific rules about communication were identified in relation to three major domains: family; gender, and emotional expression. Egyptian students perceived emotional aspects of Western doctors' communication strikingly negatively, viewing these doctors as problematically cold and unresponsive.
  
  
  CONCLUSIONS
  Contradictory perceptions of 'good communication' in future doctors are found cross-continentally and may contribute to prevalent cultural misunderstandings in medicine. The lack of global consensus on what defines good communication challenges prescriptively taught Western 'patient-centredness' and questions assumptions about international transferability. Health care professionals must be educated openly about flexible, context-specific communication patterns so that they can avoid cultural incompetence and tailor behaviours in ways that optimise therapeutic outcomes wherever they work around the globe.
authors.affiliation: Department of Psychiatry, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK.
authors.forename: Tom B
authors.initials: TB
authors.lastname: Mole
authors.affiliation: Department of Primary Care, School of Primary Care, Health Education Yorkshire and the Humber, University of Leeds, Leeds, UK.
authors.forename: Hasna
authors.initials: H
authors.lastname: Begum
authors.affiliation: Department of Primary Care, Institute for Primary Care and Health Sciences, Keele University, Keele, UK.
authors.forename: Nicola
authors.initials: N
authors.lastname: Cooper-Moss
authors.affiliation: Division of Health Sciences, Warwick Medical School, Warwick University, Coventry, UK.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Wheelhouse
authors.affiliation: Department of Primary Care, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK.
authors.forename: Pieter
authors.initials: P
authors.lastname: MacKeith
authors.affiliation: Section of Public Health, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK.
authors.forename: Tom
authors.initials: T
authors.lastname: Sanders
authors.affiliation: Department of Medical Education, Faculty of Health, Keele University, Keele, UK.
authors.forename: Valerie
authors.initials: V
authors.lastname: Wass
mesh_terms: D000328:Adult; D003142:Communication; D054521:Cultural Competency; D004501:Education, Medical; D004534:Egypt; D005260:Female; D017144:Focus Groups; D066296:Grounded Theory; D006801:Humans; D007194:India; D008297:Male; D018802:Patient-Centered Care; D010817:Physician-Patient Relations; D013337:Students, Medical / Q000523:psychology*; D006113:United Kingdom; D055815:Young Adult