Words that count
When the consultation is being observed, one way of studying these communication skills is by concentrating on the doctor rather than the patient, on the process rather than the content of the consultation. The biomedical model separates the process of consulting from the outcome, thinking from doing, and the acquisition of knowledge from the exercising of it. Wording of diagnosis matters. A diagnosis of osteoarthrosis implying irreversible degeneration, progressive pain, and inevitable loss of function is pathogenic. A diagnosis of strain suggesting the possibility of recovery is salutogenic. Words have the potential to heal or to harm. Where diagnosis is uncertain and treatment options limited, doctors have little more than words to offer. The verbal skills doctors use in the consultation form a spectrum from the most patient-centred to the most doctor-centred. The first—and most patient-centred—skill is acknowledgement, saying ‘Yes, uh-huh’. This will encourage the patient to talk.