Verbal and non-verbal behavior of doctors and patients in primary care consultations - how this relates to patient enablement

Patient Educ Couns. 2012 Jan;86(1):70-6. doi: 10.1016/j.pec.2011.04.019. Epub 2011 May 28.


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.

Conclusion: 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.

Practice implications: To support patient enablement in consultations, clinicians should focus on agreements, approvals and legitimization whilst attending to patient agendas.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Communication
  • Female
  • Health Status Indicators
  • Humans
  • Kinesics*
  • Logistic Models
  • Male
  • Middle Aged
  • Models, Psychological
  • Patient-Centered Care
  • Personal Autonomy*
  • Physician-Patient Relations*
  • Power, Psychological*
  • Primary Health Care / methods*
  • Psychometrics
  • Qualitative Research
  • Referral and Consultation
  • Verbal Behavior*