Empathic communication sequences in online medical consultations

A case study from China

Authors

  • Yu Zhang Beijing Information Science and Technology University

DOI:

https://doi.org/10.1558/cam.19694

Keywords:

China, clinical empathic communication, interactional sequence, online medical consultation (OMC), theme-oriented discourse analysis

Abstract

Empathy is believed to play a key function in clinical consultations. As online medical consultation (OMC) has become increasingly popular in the past decade, studies addressing empathic communication in the OMC context have started to attract research interest. However, previous studies have mainly addressed empathic communicative acts by online doctors. There is still a research gap as regards exploring online empathic communication from both doctors’ and patients’ perspectives, particularly in the context of China where there is a promising growth in OMC activities. The present study examines 150 text-based OMC cases that involve empathic interaction between doctors and patients/caregivers in the Chinese context. Adopting a theme-oriented discourse analysis approach, the paper aims to identify empathic communication sequences. Four types of sequence organization are identified, and these are discussed with relevant examples. The findings illustrate that OMC communication involves dynamic empathic sequential patterns, which can be optimally drawn upon by health professionals and medical students to practise their empathic communication skills.

Author Biography

Yu Zhang, Beijing Information Science and Technology University

Yu ZHANG (张宇) received her PhD degree from Hong Kong Baptist University and currently holds a teaching position at Beijing Information Science and Technology University, Beijing. Her major research interest is discourse studies in the context of health communication and medical humanities. Her work related to online health communication has been published in Health Communication, Discourse & Communication, Chinese Journal of Communication and Communication & Medicine, and another journal article related to online medical consultations will be published in Pragmatics and Society.

References

Beckman, Howard B., Kathryn M. Markakis, Anthony L. Suchman and Richard M. Frankel (1994) The doctor–patient relationship and malpractice: Lessons from plaintiff depositions. Archives of Internal Medicine 154 (12): 1365–1370. https://doi.org/10.1001/archinte.1994.00420120093010

Bolander, Brook and Miriam A. Locher (2014) Doing sociolinguistic research on computer-mediated data: A review of four methodological issues. Discourse, Context & Media 3: 14–26. https://doi.org/10.1016/j.dcm.2013.10.004

Bonvicini, Kathleen A., Michael J. Perlin, Carma L. Bylund, Gregroy Carroll, Ruby A. Rouse and Michael G. Goldstein (2009) Impact of communication training on physician expression of empathy in patient encounters. Patient Education and Counselling 75 (1): 3–10. https://doi.org/10.1016/j.pec.2008.09.007

Branch Jr, William T., David Kern, Paul Haidet, Peter Weissmann, Catherine F. Gracey, Gary Mitchell and Thomas Inui (2001) Teaching the human dimensions of care in clinical settings. Journal of the American Medical Association 286 (9): 1067–

https://doi.org/10.1001/jama.286.9.1067

Chen, Jiang Y. and Hong Y. Zhao (2013) An analysis of the reasons of patients’ complaints about outpatient service of primary hospitals and the strategies [in Chinese]. Gansu Medical Journal 32 (7): 549–552.

Del Piccolo, Lidia, Hanneke De Haes, Cathy Heaven, Jesse Jansen, William Verheul, Jozien Bensing, Svein Bergvik et al. (2011) Development of the Verona coding definitions of emotional sequences to code health providers’ responses (VR-CoDES-P) to patient cues and concerns. Patient Education and Counseling 82 (2): 149–155. https://doi.org/10.1016/j.pec.2010.02.024

Friedlmeier, Wolfgang (1993) Selbstkonzept und prosozialem Handeln in der Kindheit [Development of empathy, self-concept and prosocial action in childhood]. Konstanz: Hartung-Gorre.

Halpern, Jodi (2003) What is clinical empathy? Journal of General Internal Medicine 18 (8): 670–674. https://doi.org/10.1046/j.1525-1497.2003.21017.x

Hsu, Ian, Somnath Saha, Phillip T. Korthuis, Victoria Sharp, Jonathon Cohn, Richard D. Moore and Mary C. Beach (2012) Providing support to patients in emotional encounters: A new perspective on missed empathic opportunities. Patient Education and Counseling 88 (3): 436–442. https://doi.org/10.1016/j.pec.2012.06.015

Jiang, L. Crystal, Natalya N. Bazarova and Jeffrey T. Hancock (2013) From perception to behavior: Disclosure reciprocity and the intensification of intimacy in computer-mediated communication. Communication Research 40 (1): 125–143. https://doi.org/10.1177/0093650211405313

Jin, Guanghui, Yali Zhao, Chao Chen, Wenji Wang, Juan Du and Xiaoqin Lu (2015) The length and content of general practice consultation in two urban districts of Beijing: A preliminary observation study. PloS ONE 10 (8): Article e0135121. https://doi.org/10.1371/journal.pone.0135121

Jones, Rodney H. (2013) Health and Risk Communication: An Applied Linguistic Perspective. London: Routledge

Kennifer, Sarah L., Stewart C. Alexander, Kathryn I. Pollak, Amy S. Jeffreys, Maren K. Olsen, Keri L. Rodriguez, Robert M. Arnold and James A. Tulsky (2009) Negative emotions in cancer care: Do oncologists’ responses depend on severity and type of emotion? Patient Education and Counseling 76 (1): 51–56. https://doi.org/10.1016/j.pec.2008.10.003

Lundin, U. and E. Elmerstig (2015) ‘Desire? Who needs desire? Let’s just do it!’ – A qualitative study concerning sexuality and infertility at an internet support group. Sexual and Relationship Therapy 30 (4): 433–447. https://doi.org/10.1080/14681994.2015.1031100

Mao, Yansheng and Xin Zhao (2020) By the mitigation one knows the doctor: Mitigation strategies by Chinese doctors in online medical consultation. Health Communication 35 (6): 667–674. https://doi.org/10.1080/10410236.2019.1582312

Mercer, Stewart W. and William J. Reynolds (2002) Empathy and quality of care. British Journal General Practice 52 (Suppl.): 9–12.

Neumann, Melanie, Jozien Bensing, Stewart Mercer, Nicole Ernstmann, Oliver Ommen and Holger Pfaff (2009) Analyzing the ‘nature’ and ‘specific effectiveness’ of clinical empathy: A theoretical overview and contribution towards a theory-based research agenda. Patient Education and Counseling 74 (3): 339–346. https://doi.org/10.1016/j.pec.2008.11.013

Ning, Dehuang and Shanshan Wei (2015) A review on the domestic researches of doctor–patient communication in China in recent years. Journal of Kunming University of Science and Technology 15 (6): 6–11.

Park, Min Sook and Hyejin Park (2016) Topical network of breast cancer information in a Korean American online community: A semantic network analysis. Information Research: An International Electronic Journal 21 (4): Article 4.

Poole, Desmond A. and Robert W. Sanson-Fisher (1979) Understanding the patient: A neglected aspect of medical education. Social Science and Medicine. Part A: Medical Psychology and Medical Sociology 13: 37–43. https://doi.org/10.1016/0271-7123(79)90006-3

Pounds, Gabrina (2010) Empathy as ‘appraisal’: A new language-based approach to the exploration of clinical empathy. Journal of Applied Linguistics and Professional Practice 7 (2): 139–162. https://doi.org/10.1558/japl.v7i2.145

Pounds, Gabrina (2018) Patient-centred communication in ask-the-expert healthcare websites. Applied Linguistics 39 (2): 117–134.

Pounds, Gabrina and Carlos De Pablos-Ortega (2015) Patient-centred communication in British, Italian and Spanish Ask-the-Expert healthcare websites. Communication and Medicine 12 (2–3): 225–241. https://doi.org/10.1558/cam.27231

Roberts, Celia and Srikant Sarangi (2005) Themeoriented discourse analysis of medical encounters. Medical education 39 (6): 632–640. https://doi.org/10.1111/j.1365-2929.2005.02171.x

Ruusuvuori, Johanna (2007) Managing affect: Integration of empathy and problem-solving in health care encounters. Discourse Studies 9 (5): 597–622. https://doi.org/10.1177/1461445607081269

Salmon, Peter and Bridget Young (2005) Core assumptions and research opportunities in clinical communication. Patient Education and Counseling 58 (3): 225–234. https://doi.org/10.1016/j.pec.2005.05.018

Silverman, Jonathan, Suzanne Kurtz and Juliet Draper (2016) Skills for Communicating with Patients (3rd edition). Boca Raton, FL: CRC Press. https://doi.org/10.1201/9781910227268

Suchman, Anthony L., Kathryn Markakis, Howard B. Beckman and Richard Frankel (1997) A model of empathic communication in the medical interview. Journal of the American Medical Association 277 (8): 678–682. https://doi.org/10.1001/jama.1997.03540320082047

Thompson, Oonagh, Giorgos Koumanakos and Karim Hadjri (2012) The ethical and policy implications of e-health and telemedicine: An ageing-focused review. Clinical Ethics 7 (4): 147–156. https://doi.org/10.1258/ce.2012.012020

Vimalananda, Varsha G., Gouri Gupte, Siamak M. Seraj, Jay Orlander, Dan Berlowitz, Benjamin G. Fincke and Steven R. Simon (2015) Electronic consultations (e-consults) to improve access to specialty care: A systematic review and narrative synthesis. Journal of Telemedicine and Telecare 21 (6): 323–330. https://doi.org/10.1177/1357633X15582108

Wei, Chun Y. (2015) Study of pragmatic empathy in doctor-patient interaction. Journal of North University of China 31 (3): 73–78.

Wu, Qing, Li Zhao and Xu-Chun Ye (2016) Shortage of healthcare professionals in China. British Medical Journal 22 (354): 1–2. https://doi.org/10.1136/bmj.i4860

Wynn, Rolf (2005) Empathy in general practice consultations: A qualitative analysis. Epidemiology and Psychiatric Sciences 14 (3): 163–169. https://doi.org/10.1017/S1121189X00006412

Wynn, Rolf and Michael Wynn (2006) Empathy as an interactionally achieved phenomenon in psychotherapy: Characteristics of some conversational resources. Journal of Pragmatics 38 (9): 1385–1397. https://doi.org/10.1016/j.pragma.2005.09.008

Ye, Qing Y. and Jian G. Wang (2015) Analysis on cause of out-patient’s complaints in a hospital, Wuhan [in Chinese]. Medicine and Society 28 (2): 55–57.

Zhang, Yan (2010) Contextualizing consumer health information searching: An analysis of questions in a social Q&A community. In Proceedings of the 1st ACM International Health Informatics Symposium, 210–219. New York: ACM. https://doi.org/10.1145/1882992.1883023

Zhang, Yu (2020) How doctors do things with empathy in online medical consultations in China: A discourse analytic approach. Health Communication. Online first. https://doi.org/10.1080/10410236.2020.1712527

Zhang, Yu (forthcoming) Discursive positioning of doctors and e-patients in online medical consultations in China: An orientation toward affective affiliation. Pragmatics and Society.

Zhao, Xin and Yansheng Mao (2021) Trust me, I am a doctor: Discourse of trustworthiness by Chinese doctors in online medical consultation. Health Communication 36 (3): 372–380. https://doi.org/10.1080/10410236.2019.1692491

Zhao, Zhao and Weixin Sun (2016) Survey research on the use of health information in online q & a communities [in Chinese]. Journal of Medical Informatics 37 (5): 14–19.

Zimmermann, Christa, Lidia Del Piccolo, Jozien Bensing, Svein Bergvik, Hanneke De Haes, Hilde Eide, Ian Fletcher et al. (2011) Coding patient emotional cues and concerns in medical consultations: The Verona coding definitions of emotional sequences (VR-CoDES). Patient Education and Counseling 82 (2): 141–148. https://doi.org/10.1016/j.pec.2010.03.017

Published

2021-09-01

How to Cite

Zhang, Y. (2021). Empathic communication sequences in online medical consultations: A case study from China. Communication and Medicine, 17(1), 64–75. https://doi.org/10.1558/cam.19694

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Section

Articles