How do residents perceive and narrate stories about communication challenges in patient encounters? A narrative study

OBJECTIVE: This article investigated residents’ narratives to gain their understandings of which patterns are challenging in doctor–patient conversations. DESIGN: Qualitative narratological framework. PARTICIPANTS: We analysed 259 narratives from 138 residents’ oral recounts of communication with patients in which they had felt challenged. RESULTS: The analysis identified an ideal narrative for the doctor–patient encounter with the resident as protagonist pursuing the object of helping the patient with his health problem. Disruptions of this ideal narrative were at play when challenges occurred. Regardless of medical setting, challenges were often related to the establishment of a common object, and the communication actants had to go through negotiations, disagreements or even battles when trying to reach a common object. Challenges also occurred when actants which in the ideal narrative should act as helpers become opponents. We find narratives where patients, relatives and colleagues become opponents. CONCLUSIONS: Our study showed that communication challenges were the result of disruptions of the perceived ideal narrative. Residents found it especially challenging to establish a common object, and dealing with helpers turned opponents. Patient communication is thus a challenge in the transition phase from student to doctor, and doctor–patient communication is complex in nature and continuously perceived to be so by residents, despite pregraduate training.