Physician and patient in consultation: who interrupts whom (and is that bad)?

During a GP consultation, physicians and patients may interrupt each other. These interruptions are often seen as intrusive actions by (male) physicians that hinder the patient. Linguist Ilona Plug and her colleagues investigated this assumption and discovered not only that gender is not a decisive factor, but also that interruptions can actually be positive for the course of the consultation. 

In a conversation between two people, one may interrupt the other in the middle of a turn. In general, these interruptions have a negative image: one person does not let the other person finish. In the medical world, interruptions by the physician during a consultation are often seen as intrusive actions that hinder the patient: they have less room to share relevant concerns and complaints. In addition, interruptions are associated with male dominance; a male physician is assumed to interrupt a female patient more often than vice versa.

These intuitions have so far lacked a systematic, scientific analysis of interactions in clinical practice. New research by linguist Ilona Plug and her colleagues - in cooperation with the Radboudumc - was the first to take a closer look at the interruption behaviour during a consultation.

Type of interruption

In her study, Plug distinguishes between two types of interruptions: cooperative and intrusive interruptions. ‘Intrusive interruptions are interruptions that interfere with your turn,' explains Plug. ‘We often find them a little aggressive or inappropriate. Someone might change the subject or disagree with the other person. That type of interruption damages the content and the course of the conversation. Cooperative interruptions, on the other hand, do justice to the conversation. With a cooperative interruption, the speaker can, for example, ask for clarification or show agreement, which makes it clear that both interlocutors are talking about the same thing'.

For the study, Plug analysed 84 videos of conversations between physicians and patients, lasting between 6 and 25 minutes. In the videos, she coded the type of interruption and the gender identity of the physician and the patient. In addition, the phase of the conversation in which the interruption took place was indicated. Plug: 'We distinguished two phases. The phase of presenting a problem and the phase of discussing a diagnosis or treatment plan. The problem presentation phase is the phase in which patients are given space to talk about their complaints and concerns. The discussion of the diagnosis and treatment plan, on the other hand, is regarded as the physician's task and an area of expertise.’

Results

The study by Plug and colleagues shows that 83 percent of interruptions were cooperative. Intrusive interruptions were most often made by patients and especially in the phase of problem presentation. 'We consider that to be the patient's phase. Physicians interrupted patients mainly in a cooperative manner, to show understanding and support or to ask for clarification. Cooperative interruptions by physicians in the initial phase of the consultation may therefore improve rather than hinder the quality of communication.'

The results also showed that male physicians interrupted their patients in an intrusive manner more often than female physicians, but in the patient group the female patients were the ones who used intrusive interruptions more often, for example to show disagreement or change the subject. ‘This could imply that female patients feel powerful during the medical consultation, or - on the contrary - that they feel less heard or understood than male patients', says Plug.

Mainly cooperative

Most interruptions in clinical interaction are cooperative and can enhance the interaction. Although interruptions of patients by physicians have long been regarded as intrusive actions that should be avoided, findings by Plug and her colleagues show that most interruptions by physicians are not intrusive.

Plug: 'With these data we cannot exclude that other factors also play a role in medical interactions, such as education level, status, the severity of the complaints, or the experience of the physician. We also do not know how the interruptions were experienced by the physicians and the patients. This might be revealed by future research. But based on this study, it appears that patients and physicians need not be afraid of interrupting each other. From a very linguistic point of view, a cooperative interruption is much less disruptive to the progress of the conversation than an intrusive one.

The article When interruptions do not harm the medical interaction: A quantitative analysis of physicians' and patients' interruptions in clinical practice was published on 26 September 2022 in the scientific journal Annals of Family Medicine.

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