The Weight of Words: A Mixed Methods Study to Understand Indian Doctors’ Perspectives and Experiences of Patient Communication

Background: Effective doctor communication can lead to increased treatment adherence and improved self-management among individuals living with diabetes. Yet, there is limited research in India which examines how doctors communicate, especially in terms of verbal and nonverbal communication. Aims: (1) To examine communication in clinic (verbal, nonverbal and basic content) among Indian doctors specialized in diabetes and endocrine care, and (2) to explore doctors’ styles of verbal and nonverbal communication. Methods: Using a mixed methods design, a survey containing quantitative (n=834) and qualitative (n=648) elements was filled out by doctors specialized in the fields of diabetes and endocrinology in India. Questions in the quantitative section included questions such as addressing patients’ illness-related concerns, acknowledging challenges of using insulin, and non-verbal behaviours. The qualitative section focussed on elaborating some responses made to the quantitative section, such as questions about explaining the cause of illness, listing words and phrases that may potentially impact patients, and explaining why the patients need to be initiated on insulin. The data was analysed using descriptive statistics and qualitative content analysis, respectively. Results: The findings of the quantitative study showed that the majority of the doctors (i) always greeted their patient as they entered the room (43.2%), (ii) addressed the risk of developing diabetes with patients’ siblings/children (87.9%), (iii) always acknowledged the challenges of using insulin (42.8%), and (iv) never asked patients’ experiences at the end of the consultation (31.9%). All common communication cues were rated as extremely important; eye contact (48.7%), tone of voice (41.5%), body language (39.6%), and words and phrases (41.8%). The qualitative findings revealed that doctors preferred to use verbal communication such as using authoritative language, educating patients using facts, analogies and behavioural information, employing empathetic language on occasion. Doctors also reported using negative words that portrayed fear, blame and disengagement in order to promote adherence. Discussion and Conclusion: The findings suggest that doctors rely on verbal rather than nonverbal communication when interacting with patients, with fear messages being a favoured means of ensuring adherence. It is possible that this may be because, while recognizing the value of nonverbal methods, doctors lack training in using these techniques in communication. Therefore, developing a communication skill training program for Indian doctors focussed on empathic and nonverbal communication can help to improve consultation and patient outcomes (e.g., adherence, patient satisfaction).