‘How do you know what Aunt Martha looks like?’ A video elicitation study exploring tacit clues in doctor–patient interactions
Article first published online: 6 JAN 2011
Published 2011. This article is a US Government work and is in the public domain in the USA.
Journal of Evaluation in Clinical Practice
Special Issue: Philosophy of Evidence Based Medicine
Volume 17, Issue 5, pages 933–939, October 2011
How to Cite
Henry, S. G., Forman, J. H. and Fetters, M. D. (2011), ‘How do you know what Aunt Martha looks like?’ A video elicitation study exploring tacit clues in doctor–patient interactions. Journal of Evaluation in Clinical Practice, 17: 933–939. doi: 10.1111/j.1365-2753.2010.01628.x
- Issue published online: 23 SEP 2011
- Article first published online: 6 JAN 2011
- Accepted for publication: 18 November 2010
- clinical interactions;
- clinical judgement;
- preventive services;
- qualitative research;
- tacit clues;
- video elicitation
Rationale and objectives Theory suggests that tacit clues inform clinical judgements, but the prevalence and role of tacit clues during clinical interactions is unknown. This study explored whether doctors and patients identify information likely to be tacit clues or judgements based on tacit clues during health maintenance examinations.
Methods Qualitative analysis of video elicitation interview transcripts involving 18 community-based primary care doctors and 36 patients. Outcomes were description and analysis of tacit clues and judgements based on tacit clues mentioned by participants.
Results A total of 57 references to tacit clues and 53 references to judgements based on tacit clues were identified from patient and doctor transcripts. Non-verbal behaviours comprised the most common category of tacit clues (53% of doctor comments; 42% of patient comments). Patients mostly discussed judgements based on tacit clues that related to the doctor–patient relationship. Doctors discussed actively using non-verbal behaviours to provide patients with tacit clues about the doctor–patient relationship. They also mentioned tacit clues that informed medical judgements and decision making. Gestalt judgements based on tacit clues were common (33% of doctor comments). Several participants identified instances in which they had difficulty articulating their rationale for specific judgements. Doctors varied widely in how frequently they mentioned tacit clues.
Conclusion During video elicitation interviews, patients and doctors identified tacit clues and judgements based on these clues as playing a role during health maintenance examinations. Future research should further elucidate the role of tacit clues in medical judgements and doctor–patient relationships.