Ososami, Oluwatosin; (2024) 'What's wrong with me?' – The evolution of patients' information-seeking behaviours and doctors' verbal responses within the medical consultation. Doctoral thesis (Ph.D), UCL (University College London).

Text Oluwatosin_Ososami_PhD Ososami Final Submission.pdf - Other Access restricted to UCL open access staff until 1 February 2025. Download (1MB)

Abstract

Background: Unmet patient needs, especially for diagnostic information, are a prevalent problem in healthcare impacting patients’ ability to make informed decisions. Therefore, there is a need to understand how patients verbally manifest their information needs in the medical consultation, how they are verbally addressed by doctors, and how these needs evolve over time. / Methods: 127 video-recorded simulated consultations were analysed from a United Kingdom postgraduate clinical examination. This project used a mixed-methods analysis innovatively synthesising conceptual frameworks from linguistic and information-science literature with existing healthcare research tools. Speech Act Theory, Request Entitlement and the Taxonomy of Requests by Patients were utilized to identify simulated patients’ information-seeking behaviours. Doctors’ response behaviours were identified using the concept of adjacency pairing from Conversation Analysis and an adapted version of the Verona Coding Definitions of Emotional Sequences. Bates’ Berrypicking model was used to investigate the evolution of patients’ information needs. / Results: Simulated patients manifested their information needs using two main linguistic forms – declaratives and interrogatives requests – throughout the medical consultation. Doctors provided answers or non-answers in response to these simulated patients’ requests depending on their linguistic form and timing within the consultation. Non-answers consisted of several distinct behaviours including Direct claim of lack of knowledge, Indirect claim of lack of knowledge, Postponing. When doctors provided non-answer responses to patients’ requests, patients were equally likely to (i) revisit these requests through paraphrasing, repeating, using a more specific version or (ii) not revisit these requests. However, when answers were provided, the majority of simulated patients did not revisit their requests. / Conclusion: This project highlighted the extensive range of verbal behaviours used by patients and doctors during the process of information seeking in the medical consultation. This research reveals that the verbal manifestation of patients’ information needs should be considered as a process that evolves over time.

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