206698 Examining the Subtle Distinctions between Rapport-Building and Infantilizing Communication: An Analysis of Medical Student Communication toward Patients with Disabilities

Monday, November 9, 2009

Ylisabyth S. Bradshaw, DO, MS , Department of Public Health & Family Medicine, School of Medicine, Tufts University, Boston, MA
Ashley Duggan, PhD , Communication Department, Boston College, Chestnut Hill, MA
Natalie Swergold , Boston College, Chestnut Hill, MA
Wayne Altman, MD , Department of Public Health & Family Medicine, School of Medicine, Tufts University, Boston, MA
Kathleen Chanatry , Communication Department, Boston College, Chestnut Hill, MA
Colleen Coburn , Communication Department, Boston College, Chestnut Hill, MA
Shannon Carroll , Communication Department, Boston College, Chestnut HIll, MA
Matthew Dunn , Communication Department, Boston College, Chestnut HIll, MA
Aisling Francoeur , Communication Department, Boston College, Chestnut HIll, MA
John Glass , Communication Department, Boston College, Chestnut HIll, MA
Sarah Weintraub , Communication Department, Boston College, Chestnut HIll, MA
Hilary Weismann , Communication Department, Boston College, Chestnut HIll, MA
Kathryn Zioto , Department of Public Health & Family Medicine, School of Medicine, Tufts University, Boston, MA
Doctors' communication intended to build rapport with patients may extend beyond rapport/warmth and instead may be perceived as condescending for patients with disabilities. This research examines medical students' rapport-building behaviors directed toward patients who use wheelchairs, crutches, or assistance dogs, as compared to the same medical students with other patients. The project identifies “infantilizing” communication toward patients with disabilities.

The current multi-method project employs Communication Accommodation Theory (Giles & Coupland, 1992) to describe communication between medical students and standardized patients with disabilities, and identifies a range of over-accommodation in communication behaviors toward standardized patients with disabilities. Family medicine clerkship students (N=142), each participating in two types of patient interactions, were videotaped in rotations over an academic year. Qualitative thematic analysis and quantitative cluster analysis of identified themes substantiate the subtle but consistent distinctions between rapport-building and infantilizing communication.

Results identify the ways medical students verbally responded to negative disclosure (i.e. “after college I had respiratory failure and have been in a wheelchair since”) with positive statements (i.e. “it's great you finished college”). Similarly, this project highlights the unnecessary use of “we” rather than “you” to refer to patients with disabilities (i.e. “we're doing great, aren't we?). The researchers also identified comparable themes of overly positive rapport-building in medical students' nonverbal kinesic and vocalic behavior, including out-of-context smiling, leaning forward with an overly animated face, speaking very quietly, and using higher pitch and more vocal fluctuation toward patients with disabilities. Implications for communication theory, medical education, and patient advocacy are described.

Learning Objectives:
Learning Objectives: 1) Differentiate between rapport-building and over-accommodation through the use of infantilizing communication. 2) Identify evidence of how a patient with a disability may impact medical students’ communication. 3) Describe implications for reliability and validity of ways of measuring communication in medical education. 4) Assess the role of Standardized Patient Educators in describing strengths and challenges for medical students. 5) Analyze evidence for the ways communication behaviors indicate attitude and concern. 6) Contrast initial attitudes medical students express towards caring for a person with a disability with the expressions of insight in reflection following interaction with a patient with a disability. 7) Discuss implications of naming behaviors indicative of over-accommodation in terms of research, medical education, and patient advocacy.

Keywords: Disability Studies, Providers

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I was involved in each step in the research process.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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