This study used formal conversation analysis to examine patient-physician interactions and comprehend diagnostic statements during these phases. This study, a qualitative sub-analysis, examined the diagnosis process and diagnostic uncertainty during 28 urgent care visits. Researchers examined how doctors tested their hypotheses and dealt with uncertainty by concentrating on where diagnostic statements were made during the interaction; whether certain or uncertain diagnostic statements were amended during the contact. In 3 urgent care facilities, they enrolled 28 patients from Brigham and Women’s Hospital (BWH) who were seen by 7 primary care physicians (PCPs). NVivo12 qualitative data analysis software was used to record, transcription, and coding of encounters. Using formal content and conversation analysis, data were examined inductively and deductively. In 12 different clinical settings, investigators found 62 diagnostic communication utterances. The diagnosis process began before the diagnosis phase (57% during history taking and 64% during physical examination) in most encounters (24/28, 86%). A definite diagnosis phase was not seen in 17 (61%) of them. Results demonstrate 2 nonlinearities in the diagnosing process. First, nonlinearity was seen when diagnostic statements were made at various points during the encounter’s 6 stages, integrating information from 1 phase with another. Second, nonlinearity was observed in diagnosing diagnostic uncertainty, with doctors admitting ambiguity even during quick meetings when defending their diagnostic rationale. Diagnostic assessments can be expressed at any time throughout an interaction, making possible more flexible and potentially patient-centered communication. The diagnosis was frequently more participatory and nonlinear. These findings had implications for medical education programs and can help practitioners become more effective communicators when dealing with ambiguous diagnoses.
Source: bmcprimcare.biomedcentral.com/articles/10.1186/s12875-022-01767-y
