Exploring doctor-patient communication in high stress contexts: patient involvement in shared decision-making in a Hong Kong bilingual Emergency Department
Key to patient-centred care is respect for patient treatment decisions, shared decision-making, respect for patient’s dignity and listening to both patients and their carers. (Leung et al, 2012). In a extensive survey of Hong Kong and mainland Chinese patients, it was found the HK patients strongly favoured joint decision-making. (Kim et al, 1999). However in a patient satisfaction survey of 5000 discharged patients in Hong Kong, patients reported low scores on information given to them, communication with clinicians and engagement in decision-making. (Griffith et al, 2011). This paper explores the complexity of communication in a trilingual context of an Emergency Department (ED) in Hong Kong. Through authentic recordings of the patients’ journey in the ED, transcripts of clinician-patient interaction are provided, contrasting those that effectively involve patients in their care to those where the patient is a passive recipient.
The research used complementary methods derived from quantitative and qualitative approaches, incorporating ethnography and discourse analysis, with questionnaire surveys, interviews with healthcare practitioners and management, and audio-recordings of patients’ journeys from triage to disposition. The contextual characterisation highlighted the communicative complexity of EDs—particularly the case in HK where many communicative challenges arise from the use of spoken Chinese in doctor-patient consultations, code-mixing, practitioner-practitioner communication and the use of English in medical records. We demonstrate that failure to attend to the patient’s interpersonal needs can result in inadequate, lack of compliance with treatment and patient dissatisfaction. We present a communication framework we have developed to help local practitioners establish effective communication strategies.
Jack Pun is Assistant Professor in the Department of English at City University of Hong Kong. He previously taught at the Hong Kong Baptist University, Hong Kong Polytechnic University, University of Hong Kong and University of Oxford. He holds a DPhil in Education (Applied Linguistics and Science Education) from the University of Oxford, UK, a Master of Arts in English Language Studies (Distinction) and a Bachelor degree in Chemical Technology with minor in English from the Hong Kong Polytechnic University.
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