Chapter Overview

This chapter first examines the problem of compliance and then describes Ley’s (1981, 1989) cognitive hypothesis model of communication, which emphasizes patient understanding, recall and satisfaction. This educational perspective explains communication in terms of the transfer of knowledge from medical expert to layperson. Such models of the transfer of expert knowledge assume that the health professionals behave according to their education and training, not their subjective beliefs. The chapter then looks at the role of information in terms of determining compliance and also in terms of the effect on recovery, and then reviews the adherence model, which was an attempt to go beyond the traditional model of doctor–patient communication. Next, the chapter focuses on the problem of variability and suggests that variability in health professionals’ behaviour is not only related to levels of knowledge but also to the processes involved in clinical decision-making and the health beliefs of the health professional. This suggests that many of the health beliefs described in Chapter 2 are also relevant to health professionals. Finally, the chapter examines doctor–patient communication as an interaction and the role of agreement and shared models.

This chapter covers:

• What is compliance?
• The work of Ley
• How can compliance be improved?
• The role of knowledge in doctor–patient communication
• The problem of doctor variability
• Explaining variability – the role of clinical decision-making
• Explaining variability – the role of health beliefs
• Doctor–patient communication as an interaction