communication barriers in medical setting: a...

COMMUNICATION BARRIERS IN MEDICAL

SETTING: A SOCIOLINGUISTIC ANALYSIS OF

DOCTOR-PATIENT MEDICAL DISCOURSE

By

Ejaz Mirza

NATIONAL UNIVERSITY OF MODERN LANGUAGES

ISLAMABAD

December, 2016

i

COMMUNICATION BARRIERS IN MEDICAL SETTING: A

SOCIOLINGUISTIC ANALYSIS OF DOCTOR-PATIENT

MEDICAL DISCOURSE

By Ejaz Mirza

MPhil, NUML; Islamabad, 2008

A THESIS SUBMITTED IN PARTIAL FULFILMENT OF

THE REQUIREMENTS FOR THE DEGREE OF

DOCTOR OF PHILOSOPHY In English (Linguistics)

To

FACULTY OF ENGLISH STUDIES

NATIONAL UNIVERSITY OF MODERN LANGUAGES, ISLAMABAD

Ejaz Mirza 2016

ii

THESIS AND DEFENSE APPROVAL FORM

The undersigned certify that they have read the following thesis, examined the defense, are satisfied with the overall exam performance, and recommend the thesis to the Faculty of English Studies for acceptance:

Thesis Title: Communication Barriers in Medical Setting: A Sociolinguistic Analysis of

Doctor-Patient Medical Discourse

Submitted By: Ejaz Mirza Registration #: 372-PhD/Ling/Jan 10-07

Doctor of Philosophy

English (Linguistics)

Dr. Nighat Sultana __________________________ Name of Research Supervisor Signature of Research Supervisor

Prof. Dr. Muhammad Safeer Awan __________________________

Name of Dean (FES) Signature of Dean (FES)

Maj. Gen. Zia Uddin Najam HI(M) (R) ___________________________ Name of Rector Signature of Rector

Date

NATIONAL UNIVERSITY OF MODERN LANGUAGES FACULTY OF ENGLISH STUDIES

iii

AUTHOR’S DECLARATION FORM

I Ejaz Mirza

Son of Muhammad Bashir Mirza

Registration # 372-PhD/Ling/Jan 10-07

Discipline English (Linguistics)

Candidate of Doctor of Philosophy at the National University of Modern Languages do

hereby declare that the thesis Communication Barriers in Medical Setting: A

Sociolinguistic Analysis of Doctor-Patient Medical Discourse submitted by me in

partial fulfillment of PhD degree, is my original work, and has not been submitted or

published earlier. I also solemnly declare that it shall not, in future, be submitted by me for

obtaining any other degree from this or any other university or institution.

At any time, if my statement is found to be incorrect even after the award of degree, the

university has the right to withdraw my PhD degree.

Signature of Candidate

Date Ejaz Mirza Name of Candidate

iv

PLAGIARISM UNDERTAKING

I solemnly declare that research work presented in the thesis titled Communication

Barriers in Medical Setting: A Sociolinguistic Analysis of Doctor-Patient Medical

Discourse is solely my research work with no significant contribution from my any other

person. Small contribution/help wherever taken has been duly acknowledged and that

complete thesis has been written by me.

I understand the zero tolerance policy of the HEC and National University of Modern

Languages, Islamabad towards plagiarism. Therefore I as an Author of the above titled

thesis declare that no portion of my thesis has been plagiarized and any material used as

reference is properly referred/cited.

I undertake that if I am found guilty of any formal plagiarism in the above titled thesis

even after award of PhD degree, the University reserves the rights to withdraw/revoke my

PhD degree and that HEC and the University has the right to publish my name on the

HEC/University website on which names of students placed who submitted plagiarized

thesis.

Author’s Signature:

Name: Ejaz Mirza

v

ABSTRACT

Thesis Title: Communication Barriers in Medical Setting: A Sociolinguistic Analysis

of Doctor-Patient Medical Discourse.

Doctor-patient medical discourse has not received much attention in the study of health

care service delivery in Pakistan. Despite sophisticated technologies for medical

diagnosis and treatment, communication remains the primary means by which the

doctor and the patient exchange health information. While proper communication

determines the quality of medical care, poor communication often results in

misunderstanding, causing lack of compliance, dissatisfaction, and negative health

outcome of the patients as well as an increased risk of malpractices.

In view of this situation, this sociolinguistic study was designed to explore the status of

doctor-patient medical discourse in government hospitals of district Rawalpindi. For

conducting this study, both qualitative and quantitative approaches were used as well as

extensive literature reviews, questionnaire surveys consisting of both open-ended and

closed-ended questions for doctors, and structured interview with patients were also

done. A survey from eight tehsils of district Rawalpindi was conducted. Following

convenience sampling, 400 questionnaires were distributed among the doctors of eight

tehsils of district Rawalpindi. Interviews of 24 patients were also conducted along with

observation.

The results showed how different factors such as l an guage , p atient's health literacy

and health awareness, doctors’ training in communication skills, listening

comprehension, privacy, time of consultation affect the doctor-patient medical

discourse. Therefore, it is strongly recommended that government should make training

of communication skills mandatory for doctors. Hiring of interpreters/translators can also

be helpful to overcome the miscommunication issues. There is need to appoint more

doctors in government hospitals so that they may able to give ample time to each patient.

More waiting areas should be allocated in hospitals which will make corridors less noisy.

As a result, the doctors and the patients would be able to discuss issues in a better way.

Local doctors are to be preferred for transfer at home stations.

vi

TABLE OF CONTENTS Chapter Page

THESIS AND DEFENSE APPROVAL FORM…………………………..ii

AUTHOR’S DECLARATION FORM……………………………………iii

PLAGIARISM UNDERTAKING…………………………………………iv

ABSTRACT……………………………………………………………….v

TABLE OF CONTENTS………………………………………………….vi

LIST OF TABLES.………………………………………………………...ixLIST OF FIGURES………………………………………………………..xiv

LIST OF ABBREVIATIONS……………………………………………...xv

ACKNOWLEDGEMENT…………………………………………………xvi

DEDICATION……………………………………………………………..xvii

I INTRODUCTION……………………………………………………… 1

1.1 Background of the Research…………………………………………...21.1.1 Importance of Communication in Medical Setting ………………….81.2 Rationale for the Research……………………………………………..81.3 Statement of the Problem……………………………………………....10

1.4 Significance of the Study……………………………………………....10

1.5 Delimitation…………………………………………………………....11

1.6 Objectives of the Study…………………………………………….......11

1.7 Research Questions…………………………………………………….12

1.8 Structure and Organization of the Thesis……………………………....12

1.9 Summary……………………………………………………………….13

II LITERATURE REVIEW………………………………………………..14

2.1 Communication……………………………………………………......14

2.2 Elements of Communication………………………………………......15

2.2.1 Source …………………………………………………………........15

2.2.2 Encoding…………………………………………………………….15

2.2.3 Message…………………………………………………………... . 152.2.4 Channel……………………………………………………………. 15 2.2. 5 Receiver…………………………………………………………….15

2.2.6 Decoding…………………………………………………………... 16 2.3 The Communication Process………………………………………........16

2.4 Language and Communication…………………………………….........16

2.4.1 Work Place Communication………………………………………......17

2.4.2 Miscommunication……………………………………………….... 18

2.4.3 Miscommunication at Work Place………………………………….19

2.5 Types of Communication………………………………………………..20

2.5.1 Verbal Communication....................................................................... 21

2.5.2 Non-Verbal Communication………………………………………...21

2.5.3 Written Communication……………………………………………..22

vii

2.5.4 Interpersonal Communication……………………………………… 23

2.5.5 Types of Communication based on Purpose and Style……………. 23

2.5.5 Formal Communication…………………………………………… 23

2.5.5.2 Informal Communication…………………………………………. 24

2.6 Models of Communication…………………………………………... 24

2.6.1 De Saussure’s Model of communication………………………….....24

2.6.2 Shannon-Weaver Communication Model………………………….. . 25

2.6.2.1 Criticism of Shannon-Weaver Model of Communication…………...25

2.6.3 Mole’s Communication Model…………………………………….....26

2.6.4 Jacobson’s Model of Communication………………………………..26

2.6.5 L.E.A.R.N. Model of Communication……………………………......26

2.6.6 R.I.S.K Communication Model……………………………………....27

2.6.7 A Three-Function Model of Communication………………………...27 2.6.8 Patient’s Explanatory Model of Communication………………….....27

2.7 Sociolinguistics…………………………………………………………..29

2.7.1 Ethnography of Communication…………………………………….29

2.7.2 Interactional Sociolinguistics………………………………………. 29

2.7.3 Communities of Practice…………………………………………… 30

2.8 Communication Barriers…………………………………………….........30

2.8.1 Language Barriers………………………………………………..... 31

2.8.1.1 Communication & Medical Jargons………………………………..31

2.8.2 Physiological Barriers………………………………………………..31

2.8.2.1 Hearing Impairment……………………………………………….32

2.8.2.2 Speech Disorders………………………………………………….. 32

2.8.2.3 Vision Impairment………………………………………………….32

2.8.3 Physical/Environmental Barriers……………………………………. 33

2.8.3.1 Time………………………………………………………………. 33

2.8.3.2 Space……………………………………………………………….33

2.8.3.3 Place………………………………………………………………..34

2.8.3.4 Climate……………………………………………………………....34

2.8.3.5 Noise…………………………………………………………...........34

2.8.4 Attitudinal Behaviours……………………………………………….34

2.8.4.1 Abstracting………………………………………………………….34

2.8.4.2 Emotional Editing…………………………………………………..35

2.8.4.3 Stereotypes………………………………………………………….35

2.8.4.4 Prejudice……………………………………………………………35

2.8.5 Cultural Barriers………………………………………………………35

2.8.6 Social Barriers………………………………………………………...36

2.9 Defining the “Doctor-Patient” Relationship………………………………37

2.9.1 The Doctor-Patient Relationship: a historical perspective……………38

2.10 Summary……………………………………………………………….42

III RESEARCH METHODOLOGY…………………………………………….43

3.1 Type of Research……………………………………………………….....43

3.2 Design of the Study……………………………………………………….43

viii

3.3 Theoretical Framework… ……………………………………………… 44

3.3.1 Patient Characteristics ………………………………………………...45

3.3.2 Doctor’s Characteristics………………………………………………45

3.3.3 Contextual Characteristics…………………………………………… 45

3.3.4 Consultation Medium…………………………………………………45

3.4 Sampling………………………………………………….......................... 46

3.5 Instrumentation…………………………………………………………....49

3.5.1 Construction of the Questionnaire……………………………………..49

3.5.2 Piloting of the Questionnaire…………………………………………..50

3.5.3 Designing and conducting Interviews…………………………………51

3.6 Analysis and Interpretation of Data……………………………………....52

3.6.1 Organization of Data……………………………………………….....52

3.7 Summary………………………………………………………………….57

IV DATA PRESENTATION AND ANALYSIS……………………………….58

4.1 Analysis of Demographic Information………………………………........58

4.2 Analysis of Close-Ended Part………………………………………...........61

4.2.1 Single Item-Analysis…………………………………………………...62

4.2.2 Construct wise Analysis……………………………………………......191

4.3 Analysis of Open-ended Part………………………………………...........200

4.3.1 Demographics………………………………………………………......201

4.4 Analysis of Interviews…………………………………………………....210

4.5 Observation……………………………………………………………….. 221

4.6 Summary…………………………………………………………………. 224

V FINDINGS, RECOMMENDATIONS, &DISCUSSION…………………..225

5.1 Summary……………………………………………………………….......225

5.2 Findings and Data Interpretations……………………………………….....225

5.3 Fulfillment of Objectives…………………………………………………..227

5.4 Contribution of the Study………………………………………………….231

5.5 Recommendations ………………………………………………………...231

5.6 Suggestions………………………………………………………………...234

5.7 Limitations of the Study…………………………………………………...235

5.8 Discussion ………………………………………………………………....235

REFERENCES

Appendix A Questionnaire for Doctors………………………………………...iAppendix B Interview Questions for Patients………………………………….vii

ix

LIST OF TABLES Table Title Page

3.1 Tehsil wise distribution of the number of questionnaires…………………. 48

3.2 Cronbach alpha values of subscales of the questionnaire…………………. 50

3.3 Demographic information………………………………………………… 53

3.4 Linguistic factors…………………………………………………………...54

3.5 Social factors……………………………………………………………… 55

4.1 Sex (Demographic information)……………………………………………59

4.2 Age (Demographic information)……………………………………………59

4.3 Marital status (Demographic information…………………………………. 60

4.4 Professional experience (Demographic information) ……………………... 60

4.5 Job designation (Demographic information)………………………………. 61

4.6 Sex-based variation in the responses to LF 1……………………………… 62

4.7 Marital status-based variation in the responses to LF 1………………….....63

4.8 Professional experience-based variation in the responses to LF 1………… 63


4.10 Marital status-based variation in the responses to LF 2………………… 65

4.11 Professional experience-based variation in the responses to LF 2 ………67



4.14 Professional experience-based variation in the responses to LF 3…………69



4.17 Professional experience-based variation in the responses to LF 4………… 71

4.18 Sex-based variation in the responses to LF 5……………………………….73

4.19 Marital status-based variation in the responses to LF 5………………… 73 4.20 Professional experience-based variation in the responses to LF5………. 74


4.22 Marital status-based variation in the responses to LF 6………………….....76

4.23 Professional experience-based variation in the responses to LF 6………….76


4.25 Marital status -based variation in the responses to LF 7……………….. 78

4.26 Professional experience -based variation in the responses to LF 7…….. 79



4.29 Professional experience-based variation in the responses to LF8……….. 81


4.31 Marital status-based variation in the responses to LF 9…………………… 83

4.32 Professional experience -based variation in the responses to LF 9…………84

4.33 Sex-based variation in the responses to LF 10…………………………….. 85

4.34 Marital status-based variation in the responses to LF 10………………….. 86

4.35 Professional experience-based variation in the responses to LF 10……….. 86

4.36 Sex-based variation in the responses to DT11……………………………. 87

4.37 Marital status-based variation in the responses to DT11…………………. 88

4.38 Professional experience-based variation in the responses to DT11……. 89

4.39 Sex-based variation in the responses to DT12…………………………….. 90

x

4.40 Marital status-based variation in the responses to DT12……………………91

4.41 Professional experience-based variation in the responses to DT12………... .91

4.42 Sex-based variation in the responses to DT13……………………………... .93

4.43 Marital status-based variation in the responses to DT13…………………... 93

4.44 Professional experience-based variation in the responses to DT13 ……… 94

4.45 Sex-based variation in the responses to DT14…………………………....... 95

4.46 Marital status-based variation in the responses to DT14………………… 96

4.47 Professional experience-based variation in the responses to DT 14……….. 96

4.48 Sex-based variation in the responses to DT15………………………………98


4.50 Professional experience-based variation in the responses to DT15…………99



4.53 Professional experience-based variation in the responses to DT16…………101



4.56 Professional experience-based variation in the responses to DT17…….... 104

4.57 Sex-based variation in the responses to SP18……………………………… 105

4.58 Marital status-based variation in the responses to SP18…………………….106

4.59 Professional experience-based variation in the responses to SP18……… 106

4.60 Sex-based variation in the responses to SP19……………………………….108

4.61 Marital status-based variation in the responses to SP19……………….....…108

4.62 Professional experience-based variation in the responses to SP19………….109

4.63 Sex-based variation in the responses to SP20……………………………… 110

4.64 Marital status-based variation in the responses to SP20………………….....111

4.65 Professional experience-based variation in the responses to SP20……….....111

4.66 Sex-based variation in the responses to SP21 ………………………………113


4.68 Professional experience-based variation in the responses to SP21………….114

4.69 Sex-based variation in the responses to SP22……………………………….115


4.71 Professional experience-based variation in the responses to SP22……….. 116

4.72 Sex-based variation in the responses to LC23………………………….. 118

4.73 Marital status-based variation in the responses to LC23……………….. ....118

4.74 Professional experience-based variation in the responses to LC23……...... 119

4.75 Sex-based variation in the responses to LC24……………………………...120

4.76 Marital status-based variation in the responses to LC24……………….. ....121

4.77 Professional experience-based variation in the responses to LC24…………121

4.78 Sex-based variation in the responses to LC25………………………………123

4.79 Marital status-based variation in the responses to LC25…………………....123

4.80 Professional experience-based variation in the responses to LC25…………124

4.81 Sex-based variation in the responses to LC26………………………………125

4.82 Marital status-based variation in the responses to LC26…………………. 126

4.83 Professional experience-based variation in the responses to LC26………. 126

4.84 Sex-based variation in the responses to JT 27………………………………128

4.85 Marital status-based variation in the responses to JT 27…………………....128

xi

4.86 Professional experience-based variation in the responses to JT 27…………129


4.88 Marital status-based variation in the responses to JT 28……………………131

4.89 Professional experience-based variation in the responses to JT 28………. 131


4.91 Marital status-based variation in the responses to JT 29……………………133



4.94 Marital status-based variation in the responses to JT 30………………..... 135


4.96 Sex-based variation in the responses to G31………………………………. 137

4.97 Marital-based variation in the responses to G 31……………………….. ....138

4.98 Professional experience-based variation in the responses to G 31……......... 138

4.99 Sex-based variation in the responses to G32………………………………. 139

4.100 Marital status-based variation in the responses to G32…………………......140

4.101 Professional experience-based variation in the responses to G32………......140

4.102 Sex-based variation in the responses to G33……………………………......142

4.103 Marital status-based variation in the responses to G33…………………......142

4.104 Professional experience-based variation in the responses to G33…………..143

4.105 Sex-based variation in the responses to G34………………………………..144

4.106 Marital status-based variation in the responses to G34……………………..144

4.107 Professional experience-based variation in the responses to G34………......145

4.108 Sex-based variation in the responses to G35………………………………..146

4.109 Marital status-based variation in the responses to G35…………………….. 146

4.110 Professional experience-based variation in the responses to G35………….. 147

4.111 Sex-based variation in the responses to P36…………………………………148

4.112 Marital status-based variation in the responses to P36……………………....149

4.113 Professional experience-based variation in the responses to P36…………....149

4.114 Sex-based variation in the responses to P37………………………………....150

4.115 Marital status-based variation in the responses to P37…………………… ....151

4.116 Professional experience-based variation in the responses to P37……………152


4.118 Marital status-based variation in the responses toP38……………………… 153

4.119 Professional experience-based variation in the responses toP38…………… 154


4.121 Marital status-based variation in the responses to P39……………………....155

4.122 Professional experience-based variation in the responses to P 39…………...156

4.123 Sex-based variation in the responses to P40……………………………… ...157

4.124 Marital status-based variations in the responses to P40…………………. ....158

4.125 Professional experience-based variation in the responses to P 40…………..158

4.126 Sex-based variation in the responses to P41……………………………… ..159

4.127 Marital status-based variation in the responses to P41……………………...160

4.128 Professional experience-based variation in the responses to P41…………...160

4.129 Sex-based variation in the responses to LS 42……………………………....162

4.130 Marital status-based variation in the responses to LS 42…………………....162

4.131 Professional experience-based variation in the responses to LS 42…………163

xii

4.132 Sex-based variation in the responses to LS 43…………………………… ...164

4.133 Marital status-based variation in the responses to LS 43…………………....164

4.134 Professional experience-based variation in the responses to LS 43………… 165

4.135 Sex-based variation in the responses to LS44)……………………………… 166

4.136 Marital status-based variation in the responses to LS44……………………. 167

4.137 Professional experience-based variation in the responses to LS 44………… 167

4.138 Sex-based variation in the responses to LS 45……………………………… 168

4.139 Marital status-based variation in the responses to LS 45…………………… 168

4.140 Professional experience-based variation in the responses to LS 45………….169

4.141 Sex-based variation in the responses to T 46………………………………171

4.142 Marital status-based variation in the responses to T 46……………………171

4.143 Professional experience-based variation in the responses to T 46…………172



4.146 Professional experience-based variation in the responses to T 47…………174



4.149 Professional experience-based variation in the responses to T48………… 176


4.151 Marital-based variation in the responses to T 49………………………….. 177

4.152 Professional experience-based variation in the responses to T 49………….178

4.153 Sex-based variation in the responses to T 50……………………………… 179

4.154 Marital status-based variation in the responses to T 50…………………… 179

4.155 Professional experience-based variation in the responses to T 50………….180

4.156 Sex-based variation in the responses to ED 51……………………………..181

4.157 Marital status-based variation in the responses to ED 51…………………..181

4.158 Professional experience-based variation in the responses to ED 51………. 182

4.159 Sex-based variation in the responses to ED 52……………………………. 183

4.160 Marital status-based variation in the responses to ED 52…………………. 183

4.161 Professional experience-based variation in the responses to ED 52………..184

4.162 Sex-based variation in the responses to ED 53……………………………..185

4.163 Marital status-based variation in the responses to ED 53…………………. 185


4.165 Sex-based variation in the responses to ED54……………………………...187

4.166 Marital status-based variation in the responses to ED 54…………………..187


4.168 Sex-based variation in the responses to ED 55………………………...….. 189

4.169 Marital status-based variation in the responses to ED 55…………...…….. 189

4.170 Professional experience-based variation in the responses to ED 55...…….. 190

4.171 From LF1to LF10…………………………………………………...………192

4.172 From DT11to DT17………………………………………………………....193

4.173 From SP18 to SP22………………………………………………………….194

4.174 From LC23 to C24…………………………………………………………. 194

4.175 From JT27 to JT30…………………………………………………………..196

4.176 From G31 to G35……………………………………………………………196

4.177 From G36 to G41…………………………………………………………....196

xiii

4.178 From LS42 to LS45………………………………………………………….. 197

4.179 From T46 to T50…………………………………………………………….. 197

4.180 From ED51 to ED55…………………………………………………………. 198

4.181 Linguistic factors…………………………………………………………….. 199

4.182 Social factors………………………………………………………………….200

4.183 Demographic information of open-ended data………………………………. 201

4.184 Presentation of data from open-ended question 1…………………………….201

4.185 Presentation of data from open-ended question 2…………………………….206

xiv

LIST OF FIGURES

Figure 1 Saussure’s model of the special circuit…………………………………… 24

Figure 2 Shannon and Weaver’s information theory model of communication…… 25

Figure 3 The L.E.A.R.N model by Berlin and Fowkes…………………………….. 27

Figure 4 Map of Rawalpindi city showing eight tehsils……………………………. 47

Figure 5 Miller’s conceptual framework……………………………………………232

xv

LIST OF ABBREVIATIONS

MS Marital status

PE Professional experience

LF Language factor

DT Doctors’ training

SP Speaking proficiency

LC Listening comprehension

J/MT Jargon/ Medical terminology

G Gender

P Personality

LS Location and setting

ED Education

xvi

ACKNOWLEDGEMENT

I should like to express my appreciation to each and every one who helped me

during the process of my research. First of all, I would like to express my heartfelt thanks

to my guide Dr Nighat Sultana for her constant guidance, feedback and invaluable

suggestions during the process of writing this dissertation. She allowed a reasonable

degree of independence and guided me with a sense of justice and fairness while

remaining true to the discipline of research.

I would also like to thank the Rector NUML, Maj. Gen. (Retd) Zia Uddin Najam,

HI(M) and the Dean, Faculty of English Studies , Prof. Dr Muhammad Safeer Awan for

allowing me to work on this thesis. Also my gratitude and thanks go to the Head of the

English Department (UGS) who encouraged and facilitated me a lot to go ahead with my

thesis.

I should never forget to thank both my much-loved parents, all my dear teachers,

lovely siblings, my wife and kids. I am greatly obliged to my brother Dr Arshad Bashir

Mirza and Ms Hajra Arshad for their enormous help and support.

My very special thanks go to my friend Mr. Khurram Shahzad whose help,

inspiring thoughts and encouragement helped me all the way through my research and

writing of this thesis. I must bring up all the research participants and the friends who

facilitated my meetings with them and helped in the survey. It is important to mention

those friends and colleagues who have ever been a great help for me. The group includes

Dr. Ayyaz Mahmood , Mr. Bashir Ahmad Khan, Mr. Zawar Hashmi, Mr Muhammad

Assad Saleem Malik , Mr Nazik Hussain and Mr. Ahsan Afzal. I am thankful to Dr Tariq

Rasheed, Dr Farid Ahmed, and Dr Sohail Raja for making data collection possible for

me.

I cannot forget Dr. Arshad Mahmood, Dr.Muhammad Uzair and Dr. Hazrat Umar

who answered all my queries with a smile in difficult times. I am grateful to my spouse

for her timely support, keen interest, and valuable contribution. Lastly, I offer my regards

and blessings to all those who supported me in any respect during the completion of this

project.

xvii

DEDICATION

To my beloved wife and parents

1

CHAPTER I

INTRODUCTION

Language is a form of human ability to acquire and use complex system of

communication. It is the utmost achievement of human mind and has the dominant

unifying effects. Language is the supreme intellectual activity that is in practice. Different

languages have conquered the world at different periods of history; these include Latin,

Greek, Persian and Arabic etc. In modern times, English has got a supreme position to

connect people in this globalized world. It is unquestionably the most central and widely

spoken language in the world today. English is the most extensively used language of the

Commonwealth countries; the USA, the African States, China, Japan, Indonesia and

most of the European and Asian countries. Thousands of scholars and scientists working

in the laboratories and libraries, in many lands, publish the results of their researches in

English. It has become language of science, technology and commerce industry. There is

thus a constant flow of fresh knowledge in English language and a large number of books

and standard journals are issued every year incorporating the latest advances in thought in

all subjects.

Since all information about latest inventions is published in English, it is by

learning English that our technicians gain first-hand knowledge of machinery and

equipment imported from abroad. The knowledge of English is a necessity to all

members of our technical professions in order to keep them abreast of the latest

developments in their respective fields. Science and technology equipment have standard

terminologies and procedures to be followed in order to be benefitted from the new

inventions. It is unprecedented in several ways: by increasing number of users of the

language, by its depth of penetration into societies, by its range of functions etc. English

is used for more purposes than ever before. It is an effective instrument for promoting

international understanding and good will.

2

The main purpose of language is communication. According to Karl Buhler

(1933, 1934) communication serves three distinct functions corresponding to these three

relates. Communication binds together three elements i.e. sender, recipient and topic.

Karl gave a precise formulation to the traditional model of communication as containing

three distinct elements: the speaker, addresser or sender of the message; the listener,

addressee, audience or recipient of the message; and the world or object domain that is

the topic of communication. Buhler termed these communicative functions as expression,

appeal and representation.

1.1 Background of Research

Ideally, in human beings, the social, mental and physical ability to cope with their

environment is defined as health. It is a state of functional fitness (The World Health

Organization, 2010). Health is not merely the absence of diseases or injury (Nadir, 2003).

If our health is good, we can be engaged in numerous types of healthy activities and good

health is a prerequisite for proper functioning of individuals as well as of societies.

Healthy person can play active role in development of society and the societies having

mentally and functionally fit citizen have better chances to progress. Illness leads to

depression, distress and sluggish behavior. If we are ill, distressed, or injured, we may

face the curtailment of our usual round of daily life and we may also become so

preoccupied with our state of health that other purist are of secondary importance or quite

meaningless (Jalal, 2009).

The field of medicine is playing its part to bridge the gap between science and

society. New discoveries of science and scientific knowledge are applied directly to

human health and for the well being of individuals in societies, which is the foundation of

clinical practice. Paramedics play their role of agents in spreading general awareness

about scientific knowledge. Within this area of health care, the role of a doctor is that of

an important agent through whom this scientific understanding is expressed.

Nevertheless, the sphere of medicine encompasses something greater than the sum of our

knowledge of this age-old science. Medicine is more than sickness, disease, treatment

and prevention. It concerns the experiences, feelings, and interpretations of human beings

often in extraordinary moments of fear, anxiety, and doubt. Doctor-patient relation is

3

pivotal in treating patients. In extremely vulnerable position, it is the relationship a

patient has with a doctor that can make all the difference in quality care, and ultimately

conveys trust in the medical profession (Working Party of the Royal College of

Physicians, 2005).

Moreover, the doctor-patient relationship is a unique relationship, it is a most

trustworthy relation which a person can have with any other human being as patient

shares his pains, worries, illness and seeks guidance of the doctor. In the meantime, the

patient expects secrecy of his sickness. So, we can say that it is the most unique and

privileged relation that a person can have with another human being. A patient to a doctor

is at times like a dependent child seeking help from the doctor, he is like an eager student,

or a friend needing advice, help, sympathy, understanding and hope. Charaka, an ancient

physician, once said, "A good physician nurtures affection for his patients exactly like

the mother, father, brothers and kinds . The physician having such qualities gives life to

the patients and cures their diseases” (Sharma, 2001). This teaching relationship is the

basis of calling the physician a doctor, which originally meant teacher in Latin, whereas,

the word patient is derived from Patior, or sufferer (Etymology Dictionary Online, 2008).

Hence, a physician should not be limited to solely the diagnosis and treatment of the

patients, but s/he should also educate and encourage them in their time of need.

The doctor-patient relationship, or more specifically the interaction between the

two parties, is a central process in the practice of medicine. Talcott Parsons was the first

social scientist to theorize the doctor-patient relationship and according to him, the

physician's role is to represent and communicate [information about illness] to the patient

to control their deviance with physician and patient being protected by emotional

distance (Hughes, 1994).

Although Parson‟s view includes the two individuals being protected by

emotional distance, a good doctor-patient relationship should have some exchanged

sentiments in order to build a high-quality connection. From a modern physician‟s

perspective, the rapport begins while s/he becomes accustomed to the patient‟s

symptoms, concerns, and values. Subsequently, the physician examines the patient,

interprets the symptoms, formulates a diagnosis, and then proposes a treatment and a

follow-up plan to which the patient agrees. Moreover, it is important that the physician

4

consider the patient‟s lifestyle and their healthy demeanor. This includes life attributes

such as family, work, stress, habits and beliefs, since these often offer fundamental clues

to the patient‟s condition and further management of the problem.

Taking into consideration the doctor-patient relationship primarily depends on

communication between patient and doctor, in other words communication between the

patient and physician is the primary characteristic, which ultimately helps to define how

successful the relationship can become between the two individuals. Much of medical

care relies on information management; collection of accurate and comprehensive

patient-specific data is imperative and is the basis for proper diagnosis and prognosis. An

effective communication between doctor and patient helps doctors to get maximum

information about the illness from patients, which is essential for the diagnosis of disease.

If patient is unable to clearly communicate and tell physician about the symptoms of

sickness, diagnosis of disease can be affected. Furthermore, involving the patient in

treatment planning, eliciting informed consent, providing explanations, instructions and

education to the patient and the patient‟s family, requires effective communication

between the mentioned parties.

According to Schyve (2007), effective communication is communication that is

comprehended by both participants; it is usually bidirectional between participants, and

enables both participants to clarify the intended message. In the absence of

comprehension, the provision of health care ends, or proceeds with errors, poor quality

and risks the patient‟s safety. Effective communication ultimately leads to an enhanced

doctor-patient relationship resulting in satisfaction with the encounter by both parties and

thus improves health care outcomes. For example, without successful communication, the

patient may not feel comfortable in telling the doctor every aspect of the problem or how

it might relate to his lifestyle choices. In turn, the doctor‟s ability to make a full

assessment is compromised and the patient is more likely to distrust the diagnosis and

proposed treatment. Therefore, the quality of the doctor-patient relationship is important

for both individuals as well as for the successful cure of disease. The better the

relationship in terms of mutual respect, trust and shared values and perspectives, the finer

information will be transmitted on both directions.

5

Communication is a two way process where the sender delivers the message and

the receiver receives and interprets it. Breakdowns in communication can have serious

consequences in the medical profession, because it is through language, that a doctor

acquires much of the necessary information needed in making a proper diagnosis and

treatment. It is also through language that instructions are to be given to those who will

be performing that treatment, including the patients themselves. The small differences in

discourse between the doctor and patient could lead to radically different treatment. In a

medical setting doctors rely on their patients to provide them with important information

for making informed decisions on the proper diagnosis and treatment of various ailments.

The success of health care delivery depends greatly upon open channels of

communication between the health care provider and the patient. Language and cultural

barriers undermine the effectiveness of health care, compounding the communication

difficulties already existing in medical settings among people who share a language and a

culture and mostly use scientific terms and a discourse that is different from layman‟s

routine language. Patients may feel socially, professionally and psychologically inferior

to the physician and communication barriers can lead to weaken the doctor- patient

relationship.

Communication barriers in medical profession have been very significant

nowadays and linguists are very much concerned about this issue in this important sector.

According to Leigh (2013), Virginia Tech Carillion, located in Roanoke, Virginia, is one

of the newest US medical schools. This medical school has added a communication

component to their admission interview process. Great grades alone will not prepare

prospective students for this part of the interview process; great personal skills are

needed. Arnold (2003) states that effective communication is correlated with improved

patient satisfaction, understanding, and adherence to a physician‟s instructions. Arnold

states that the American Board of Internal Medicine stresses the use of effective

communication and an article from the American Academy of Hospice and Palliative

Medicine stated communication as a “critical skill”. Majority of the patients face serious

problems while discussing their cases or history of the disease with physicians, and in our

country, most of the people are unable to understand the pithy technical words and terms,

and therefore, it realizes that there is language-based gap in health related facilities.

6

These factors appear as a major challenge when prescriptions and other materials are

written without considering the literacy level of the patients and other service users. A

famous physician, humanitarian and teacher, Sir William Osler, who is known to have a

distinguished reputation for his work at Johns Hopkins and Oxford, was an exemplary

doctor when it came to treating a patient and teaching a student. He wanted doctors not

only to give the patient their best, but also to build a relationship with that person. He was

known for saying, "If you listen carefully to the patient they will tell you the diagnosis"

(Osler, 2008). His outlook on the doctor-patient relationship demonstrated the extreme

importance of communication between the two parties. Lack of language comprehension

can cause hindrances in developing doctor-patient relationship and these problems of

hindrances are more prominent if doctors and patients belong to different racial,

geographical and ethnic groups. In order to provide safe, high-quality health care it is

necessary to overcome this barrier to have effective communication with patients and

their families.

Verbal language problems are one aspect of obstacles that patients face while

interacting with the physicians. In addition to verbal language hurdles, patients might not

be able to read, or they read very little, even in their native language. If patient is illiterate

and unable to understand doctors‟ instructions, this makes doctors more frustrated and

lack of communication becomes a hurdle in developing good relationship with the

patient. The barrier of communication leaves the patients confused and doctors

unsatisfied. Being able to read is of utter importance in regards to quality of care received

by the patient. For example, if a doctor writes a prescription and the patient goes home

and does not remember how or when to take the prescribed medication, the situation

could become very dangerous for the patient‟s health. This dilemma can be compounded

if the patient lives in a rural area and had traveled far from home to receive the medical

care (Faux, 2002). If patient is not satisfied with the doctor‟s diagnosis, there are chances

of trust deficit between doctor and patient, and patient would avoid visiting doctor next

time.

Moreover, low health literacy of the patient is an obstacle to develop

comprehension and understanding between doctor and patient, even if they speak the

same language. Health literacy includes the ability to understand prescriptions,

7

appointment slips and doctor‟s instructions and ability to negotiate complex health care

systems (Health Literacy, 2008). Thus, being “health literate” requires a complex group

of skills like reading, listening, analytical, and decision-making, along with the ability to

apply them to health situations. When language and cultural barriers are identified

between doctor and patient, the doctor usually tries to know to what extent the patient

can understand his/her oral and written instructions and prescriptions. Contrarily, when

the two individuals speak the same language and are of the same culture, the doctor

usually believe that the patient can understand the instructions and comprehend the

communication going on between the two. The patient does not ask any questions out

of courtesy or shyness, while doctors believe that the patient has understood an

instruction that is why s/he is not asking any questions.

The communication barrier becomes a major problem in diagnosing the patient

and prescribing for her/him. Frequently the doctor realizes belatedly that the patient,

although generally literate, could not understand the medical terminology and, often

times, complex instructions. According to Woloshin, “What the scalpel is to the surgeon,

words are to the clinicians…The conversation between doctor and patient is the hearth of

the practice of medicine.” (Woloshin, 1995)

There can be several reasons why doctors do not use the interactive strategies to

deal with the patients. One of the reasons could be that doctors are not well trained about

how to use their expertise to convey full information to the patients by avoiding the use

of jargons and medical terminology. Secondly, may be the doctors may overestimate

patients‟ understanding of information and do not feel the need to explain every detail of

diagnosis to them. When patients do not understand what their physicians tell them and

they fail to comprehend doctors‟ instructions and prescriptions, the quality of health care

is being compromised.

Usually, race and ethnicity are considered important cultural barriers in doctor-

patient medical discourse. However, various other factors responsible for poor

communication between doctors and patients are still unexplored. Language barriers and

inadequate health literacy can, among other things, influence communication negatively

in healthcare encounters. It seems that healthcare providers and policy makers often

underestimate the influence of these factors on communication and health outcomes.

8

Lack of proper communication between doctor and patient can lead to serious health

issues in health care systems.

1.1.1 Importance of Communication in Medical Setting

In the field of medicine, researchers, imbedded in the health care industry,

state that when it comes to the doctor-patient relationship, communication is essential to

good medical care (Arnold, 2003). Studies have shown that effective communication

leads to improved patient outcomes and decreased malpractice claims. Indeed, effective

communication given by doctors and received by patients benefits everyone involved.

Good communication, practiced by doctors includes non-verbal communication.

Effective communication is a priority to professional medical societies. The Accredited

Counsel for Graduate Medical Education lists communication as a basic skill for all

resident doctors. Arnold states that the American Board of Internal Medicine stresses the

use of effective communication and a recent article from the American Academy of

Hospice and Palliative Medicine stated communication as a “critical skill”. Despite what

these, and subsequent studies have shown, the teaching of effective communication skills

has largely been ignored. According to Arnold, medical students spend hundreds of hours

studying biochemical and historic facts, of which they will never use.

Few schools, if there are any, spend some time in teaching the basic science of

communication. Physicians do not understand the power of words. The dilemma,

according to Arnold (2003), is that medical schools are not teaching communication

skills to students. He asks: “Why shouldn‟t schools include 10 hours in the first year

Physician & Patient Communication of learning the basic science of communication?”

With such training, medical students will communicate better with patients, other

physicians and hospital administrators. Arnold‟s is one of the few scholarly articles that

have addressed medical schools and suggest their role in teaching communication skills

to medical students. However, a more recent research has determined that medical

schools have recognized the need for communication training in their curriculum.

1.2 Rationale for the Research

People working in organizations generally regard miscommunication as an

“occupational hazard”. From a sociolinguistic perspective this is hardly surprising given

9

the complexity of language and interpersonal communication in any social context.

Moreover, in workplace settings, there is often a greater risk than elsewhere that

ineffective or problematic communication will have visible and/or costly negative

outcomes for the individuals concerned or for the organization; even in instances where

communicative trouble or mishaps pass unnoticed, they may still resurface to create

problems later. Precisely what is meant by the terms „effective communication‟ or

„miscommunication‟ is, however, seldom clearly defined or articulated in such contexts.

These terms tend to be used somewhat loosely by laypeople and workplace practitioners

to gloss a range of issues, which often go well beyond the usual scope of purely linguistic

or discursive inquiry, even though communication may well is implicated as one factor.

Training in various kinds of communication skill, or reviews and audits of

communication processes and systems, are common responses to these issues in

workplaces. Even where such interventions are appropriately targeted, they are often

based on over-simplified assumptions about language and communication and how these

operate in a socio-cultural context, rather than being grounded in linguistic, pragmatic or

interactional analysis of how people actually communicate in work settings. Academic

perspectives on language and discourse, therefore, potentially have a great deal to offer

anyone with a practical interest in improving the effectiveness of workplace

communication. There is a very large body of research literature in this area, reflecting

the amount of intellectual effort invested over many years in attempts to describe,

theorize and deconstruct concepts relating to miscommunication and other aspects of

problematic interaction.

The basic motive of this research is to explore those areas where we can minimize

communication barriers and make the communication channels clear and comprehendible

to healthcare staff. Looking from the perspective of doctor-patient relationship, we

realize that mutual discussion is very significant between doctor and a patient. The

cultural background of patient is usually ignored the patient, therefore, feels him/herself

in an embarrassing situation and cannot express his/her medical history with ease and

confidence. Therefore, major emphasis of this research is on verbal communication

taking place in the healthcare facilities. The connection between oral and written

language is pivotal in healthcare and it enables the patient to become sound

10

communicator in the treatment process. Written material, such as manuals, booklets and

medical brochures always create difficulties because the general publications contain

typical generic names (usually having Latin origin) which are very difficult to understand

by a common reader.

Therefore, communication barriers in health sector have become very significant

and most of the health professionals strongly think that the communication process

between patient and doctor needs to be made simpler and friendly. The quality of

communication between patients and hospital staff can have a major impact on health

standards and constant apathy to this issue can even jeopardize the lives of so many

patients.

1.3 Statement of the Problem

The presence of communication barriers are considered as a major threat in the

health- related services in Pakistan and this is causing series of problems in the country

both for patients and health professionals, para-medical staff and other related service

providers. These barriers are not only limited to the written prescriptions but also

associated with the cultural and social atmosphere. While studying this, we also consider

the patients‟ poor educational level where they are unable to understand the difficult

syntax and the style of the prescriptions. In this situation, the researcher tries to study the

present linguistic situation in the medical profession. Various linguistic and social factors

in this study which affect communication between doctor and patient are also expressed.

1.4 Significance of the Study

This research will identify some of the linguistic and social barriers encountered

in a large medical setting and offers some solutions to overcome these barriers. This work

also endeavors to provide guidelines to reduce day-to-day communication barriers

encountered in or outside hospitals such as patient‟s interaction with chemists and other

consultants. It helps to reduce barriers in order to fulfill the needs of the rural as well

backward urban population. If seen from another perspective, we come to know that

linguistic adaptation of medical materials is very important, as this will increase

interaction and association in hospitals and other healthcare centers. The functions of

11

different types of written material that includes admission slips, frequent prescriptions,

registration forms, and affidavits (prior to surgeries) can be made easier and consequently

it can reduce the language based barriers.

This research will enable the policy makers to realize the importance of

communication barriers in health sector and take some measures to improve this area

along with normal health practice. It will raise the awareness of what in practicing staff

for the creation of patient friendly „linguistic code of conduct‟ that will bring ease and

simplified ways for the academically poor patients. In other words, we can say that this

study will highlight the situation and steps to be taken for the improvement. The depicted

shortcomings would help the stakeholders and lawmakers to change and improve existing

strategies for the health of professionals in which hospital staff may be asked to change

their linguistic codes for the betterment of health services on moral as well as

professional grounds.

1.5 Delimitation

This study is delimited to linguistic and social factors, which affect

communication between doctor and patient in medical setting. Only five linguistic factors

that is language, doctors training in communication, speaking proficiency, listening

comprehension, and jargon/medical terminology were examined along with five social

factors like gender, personality, location and setting, time, and education during this

research.

1.6 Objectives of the Study

The study aims to have the following diagnostic and remedial objectives:

i. To discover if there exists a problem in doctors' communication with

patients in government hospitals located in the district of Rawalpindi

ii. To analyse demographic data pertaining to doctors serving in government

hospitals located in the district of Rawalpindi

iii. To identify linguistic factors that affect communication between doctors

and patients during the process of medical examination

12

iv. To explore social factors which affect communication between doctors

and patient during the process of medical examination

v. To suggest solutions to communication barriers which affect the quality of

doctor- patient communication in government hospitals located in the

district of Rawalpindi.

1.7 Research Questions

1. What are the major linguistic and social factors that affect communication

between doctors and patients at government hospitals located in the

district of Rawalpindi?

2. How does doctors‟ demography affect their communication with patients?

3. How do linguistic factors affect communication between doctors and

patients during the process of medical examination?

4. How far do social factors affect communication between doctors and

patients during the process of medical examination?

5. What suggestions may possibly be made to overcome communication

barriers between doctors and patients in medical setting?

1.8 Structure and Organization of the Thesis

I have arranged my thesis in five chapters. First chapter presents an introduction

to the study. It includes the importance of communication in medical setting and the

significance of doctors‟ training in communication. It gives the background of research,

statement of the problem, delimitation, and research questions. It highlights the objectives

and significance of the study. It also provides a brief structure and organization of the

research study that has to be conducted.

Chapter two has details of the literature, which has been reviewed in relation to

the problem under research. It highlights the issue related to the topic; raised by

prominent researchers, linguists, and doctors. The chapter helps to establish a conceptual

framework for the study.

13

Chapter three focuses on research design and methods employed in the study. It

explains the concept and importance of research, research settings, sampling and tools

used for collecting the data. It also explains the data collection process and the process

employed to analyze the data and validation of the study. The study is based on a

questionnaire, observation and some interviews.

Chapter four deals with the presentation of the data collected. It is based on the

statistical analysis of the responses to the questionnaires. Analysis and interpretation have

been done statistically by applying SPSS version 21.

Chapter five of the thesis presents summary, findings of the research, conclusions,

discussion and recommendations.

1.9 Summary

This chapter started with an introduction which included the importance and

purpose of language in the field of medicine. It was followed by background and

rationale for research. The importance of communication in medical setting was also

discussed in the light of doctor-patient interaction. The statement of problem,

significance of research and delimitation were also discussed in this chapter. Objectives

and research questions were clearly stated and briefly discussed. Contents of each chapter

were discussed in detail the heading of structure and organization of the thesis.

The next chapter deals with the review of literature.

14

CHAPTER II

LITERATURE REVIEW

This chapter deals with the review of related literature. The review is divided into

three sections. Section I deals with the literature on communication, which includes

definition, concept and explanation. It also discusses various types of communication and

related models on communication. Section II contains literature on communication

barriers. It starts from general barriers of communication and ends on specific

communication barriers in medical setting. Section III relates to literature on doctor-

patient relationship, its significance and scope. Chapter will be concluded with previous

researches on the same issue.

Section –I

2.1 Communication

The word communication has originated from a Latin word “Communes” which

means something common. In other words, communication is a process of sharing ideas,

words and attitudes, with someone. Communication is giving, receiving or exchanging

ideas, information, signals or messages through appropriate media, enabling individuals

or groups to persuade, seek information, give information or express emotions. It is a

basic human need. The phenomenon of communication is a natural desire of human

beings to express their feelings and ideas to others. The basic purpose of communication

is to bring changes in the behavior of the receiver.

15

2.2 Elements of Communication

Process of communication has six elements, which work as a tool/vehicle to share

information, ideas and attitude with someone. These elements are:

1. Source

2. Encoding

3. Message

4. Channel

5. Receiver

6. Decoding

2.2.1 Source. Communication starts with a source, a person who speaks, writes or

makes facial expressions is called the source. Source may include an individual or group

of people or an inanimate object like computer, radio, music, book, etc.

2.2.2 Encoding. In the mind of the source, message remains in the form of an

idea, the source gives a physical shape to this idea by transmitting it in words or images

then it becomes a message. This process is called encoding.

2.2.3 Message. The coded idea of the sender is called message and message is

always transmitted from source to destination. An objective of a message is to make the

receiver understood as desired by the source.

2.2.4 Channel. Channel is a medium/transmitter, which carries the message of the

sender to the receiver. TV, radio or newspapers can be considered as channel in case of

mass communication. The sensing powers of an individual are also channels of

communication such as taste, touch, smell, hearing and sight.

2.2.5 Receiver. The recipient of the message is called the receiver. It may be an

individual a group of people or an organization.

16

2.2.6 Decoding. The person who receives the message or symbol from the

communicator tries to convert the same in such a way that he may extract its meaning to

his complete understanding.

2.3 The Communication Process

Communication is always referred as a process, which guides individuals who are

involved in communication activity. It is a continuous activity and is always changing

and it is always in motion (DeVito, 1986:239). DeVito (1986: 61) notes in his writing

that communication is “ the process or act of transmitting a message from a sender to a

receiver, through a channel and with the interference of noise”. Canale (1983:04)

provides a definition of communication as „the exchange and negotiation of information

between at least two individuals through the use of verbal and non-verbal symbols,

oral and written/visual modes, and production and comprehension processes‟. Many

other scholars give detailed definitions, expanding that message transmission is a

deliberate effort to convey meaning. In simple words communication refers simply to the

transmission of a message from a sender to a receiver in an understandable manner.

Effective communication leads to understanding. A person who follows proper

communication process will be more effective in social life and professional situations.

Effective communication is crucial for professions where human interaction is involved.

Effective communication is very important for successful interactions with people of

different cultural, geographical and ethnic backgrounds.

2.4 Language and Communication

Noam Chomsky considered language as a formal system. It is explained with

respect to a “highly abstracted individual competence” (Tonkin, 2003:01); however, this

approach does not answer questions about language use in a broader social context. When

speakers are communicating they need knowledge of the topic as well as information

about the social context of the person they address. Communicative competence is very

essential; otherwise, language can hardly be effective and functional in communication.

A new interest, among scholars dealing with liberal arts such as philosophy, sociology,

psychology, pedagogy, linguistics, etc., has emerged. Language is then analyzed in terms

17

of individual competence, interactions and discourses among groups of individuals,

formal or informal system of signs and in other various ways.

Halliday (1973) defined language as an instrument of social interaction with a

clear communicative purpose. Halliday treats language as a means of a purposeful

social activity. He identified seven functions of language, in human communication

which are:

a) Instrumental

b) Regulatory

c) Interactional

d) Personal

e) Heuristic

f) Imaginative

g) Representational

The first three functions of language help the individuals to meet their physical,

emotional, and social needs, whereas the four remaining functions help individuals

make some representations of the milieu in which they live. Different linguists define

language in their own way; for instance, David crystal defines language as, “ the

systematic conventional use of sounds, signs, or written symbols in a human society

for communication and self-expression” (Crystal, 1992: 212).

Language cannot be studied in isolation from context; it is a social phenomenon.

Language variation is manifested in relation to variation in the social systems. It is so

far accepted in the literature that using a language appropriately requires knowing that

language and how to use it in its social environment. In other words, a kind of

„communicative competence‟ is required.

2.4.1 Work Place Communication. Workplace communication includes both

theoretical and applied perspectives. Workplace communication has been researched

within various theoretical paradigms. The methodological approaches vary from „micro‟

perspectives such as fine-grained analysis of natural interaction to „macro‟ or „big

picture‟ exploration of communication system and meta-discourses within the realms of

social and organizational theories.

18

2.4.2 Miscommunication. Miscommunication has been called “an interesting and

slippery concept” (Coupland, Wiemann & Giles, 1991). There had been several studies

done within theoretical paradigms and disciplinary domains, more or less focusing on

different aspects and social contexts of communication. The diversity of perspectives and

research traditions pose a considerable challenge to any researcher who is interested in

forming an integrated perspective on miscommunication and problematic talk (Coupland,

Giles and Wiemann, 1991). Coupland, Wiemann and Giles present a preliminary

typology in the form of an “integrative model of levels of analysis of

„miscommunication‟” (1991:16). Any comprehensive theoretical model of

miscommunication is still lacking because there is a lack of coherence in research.

Additionally, problematic communication is multi-faceted and highly contingent

phenomenon and there is no straightforward classification or definition provided.

Researchers have been trying to find out what counts as miscommunication (definition

and criteria), why, how and where it occurs. The “integrative model” proposed by

Coupland, Wiemann and Giles (1991), which is based on a “structural, layered

organization of perspectives on miscommunication”, was grouped according to their

underlying analytic goals and assumptions. Although the meaning of word

„miscommunication‟ is taken self-evident, review of literature shows that it is not that

easy to define the term because of related issues of classification and interpretations. The

difficulty becomes more obvious when we try to deconstruct the terminology used by

different researchers, studying different models of communication.

Coupland, Wiemann and Giles (1991) used the umbrella of phrase

“„miscommunication‟ and problematic talk” to encompass in abstract terms the full range

of phenomena they wish to consider. In literature they talk of miscommunication in this

broader sense as being “operationalised”, or “surfacing” as “misunderstandings”,

“mismatches”, “miscommunicative sequences”, “communication failure” or

“inadequacy”, “breakdown” or “misalignment”. They also comment that “in fact, it is

rarely possible to operationalise miscommunication purely at the propositional level, in

which relationships and effects are not a primary issue”. Coupland, Wiemnann and Giles

(1991) believe that all communication is intrinsically an imperfect process… language

19

use and communication are in fact pervasively and intrinsically flawed, partial and

problematic”, and that communication is thus “to that extent … itself miss-

communicative” (1991:03). Researchers like Linell (1995) advocate the idea,

„miscommunication cohabits with communication in dialogue‟. Other researchers have

recognized the analytic importance and usefulness of drawing a distinction in the

terminology they use between the overall phenomenon of „miscommunication‟ and

individual instances.

2.4.3 Miscommunication at Work Place. Literature on workplace (miss)

communication is interdisciplinary in nature and it is located within distinct domain

having largely its own audience. The literature on (miss) communication has a (cross)

disciplinary basis (e.g. applied linguistics, conversational analysis, language and gender

studies and health communication etc.).

There is abundance of literature available on institutional discourse in relatively

formal settings like meetings, job interviews, courtrooms, classrooms and medical

consultations. Embedded within this literature, lies significant work on technical aspects

of miscommunication e.g. second language acquisition, communication in technical

environment, role of communication errors etc. All these researches have interrelated

layers of meanings and methodological issues which make a theoretically well-found

categorization of „common issues‟ somewhat problematic. Literature on problematic

workplace communication can be classified into three broad groups according to the

discursive „system‟ level of analysis.

First level of analysis deals with „Linguistic or interactional oriented studies of

miscommunication‟. This kind of research explores interpersonal communication

processes and practices, and/or mismatches between the communicative norms and

discursive practices of different groups. Communication is often viewed instrumentally

as primary medium for managing interpersonal relationships in an organizational context

(Drew and Heritage, 1992). Second level of analysis focuses on language and discourse

as a mean of contesting power and status in an organizational setting where problematic

communication has deep-rooted underlying political or non-political issues. Third and

final level of analysis deals with miscommunication and communication-related error in

20

organizational and technical settings. All three levels of communication analysis focus

more often on an organizational problems of some kind, with language or discourse.

Miscommunication issues range from relatively straightforward instances of

miscommunication or misunderstanding at the most basic level. The most observable

issues of communication could be;

Straightforward instance of miscommunication or misunderstanding at the most

basic level (e.g. cases where the content or „message‟ has not been adequately

conveyed from one person to another)

Through the management of face needs and competing goals in inherently

problematic interactional activities (such as disagreement, criticism, advice-

giving, complaints, directives, refusals and conflict talk and so on);

The sequential co-construction and repair of interactional dilemmas and „trouble‟

(as in conversation analysis).

The works on miscommunication are descriptive rather than critical and these

works have a clear “practical relevance” to workplace practitioners (Roberts & Sarangi,

1999; Roberts, 2001). Different researchers are interested in developing a theoretical

account of the phenomena observed in a range of mainly formal „front stage‟ settings. For

instance, dilemmas of advice in health visitor interactions with new mothers (Heritage

and Sefi, 1992), contested evidence in courtroom cross- examination (Drew, 1992) and

the rejection of advice in a service encounter (Jefferson, 1992). Other important

collections include Sarangi and Roberts (1999), which examines discourse in medical,

mediation and management settings, and Heritage and Maynard (2006), which gathers

together a range of conversation analytic work on problematic aspects of medical

interactions.

Section –II

2.5 Types of Communication

There are many types of communication, but to delimit the scope of my study I

will shed light only on verbal, non-verbal, written and interpersonal communication.

21

2.5.1 Verbal Communication. Verbal/oral communication means using spoken

words to convey a message. Listening is equally important skill to make this type of

communication successful. Verbal communication is applicable to a wide range of

situations, ranging from informal office discussions to public speeches. Professions use

good verbal communications to foster better relationship with colleagues and employees.

Consultants are a group of professionals that need good communication skills, as they are

constantly meeting new people and need to communicate large quantities of important

information. Other forms of oral communications may include informal communications

like grapevine or informal rumor mill, and formal communications like lectures and

conferences. Clarity of speech, volume, speed, pitch and voice modulation are essentials

of effective oral conversations. Verbal communication is most successful form of

communication and it makes the process of conveying thoughts easier and faster.

2.5.2 Non-Verbal Communication. Facial expressions, gestures, body

language and postures are different forms of non-verbal communication. Non-verbal

communication involves communicating by sending and receiving wordless messages.

Non-verbal communication sets the tone of a conversation and it can seriously undermine

the message contained in words if one cannot control it carefully. For example leaning

over an employee‟s desk and invading his/her personal space can turn a friendly chat into

an aggressive confrontation that leaves the employee feeling undervalued. Non-verbal

communication usually reinforces verbal communication, but it can also convey feelings

on its own.

Physical nonverbal communication includes facial expressions, eye contact, and

body posture, gestures such as a wave, overall body movements, and tone of voice, touch,

and others. Facial expressions are the most common among all non-verbal

communications. Researchers estimate that body language, including facial expressions,

account for 55 percent of all communication.

Paralanguage that is the way something is said, rather than what is actually said, is

an important component of nonverbal communication. This includes voice quality,

22

intonation, pitch, stress, emotion, tone, and style of speaking, and communicates

approval, interest or the lack of it. Research estimates that tone of the voice accounts for

38 percent of all communications. Other forms of nonverbal communication usually

communicate one‟s personality. These include:

Aesthetic communication (dancing, painting)

Appearance (style of dressing and grooming, which communicates one‟s

personality)

Space language (paintings and landscapes communicate social status and taste)

Symbols (religious, status, or ego-building symbols)

2.5.3 Written Communication. Written communication becomes essential for

communicating complicated information and it is used to share data, statistics and

information that cannot be conveyed through speech alone. While producing a piece of

written information, one needs to be very careful and ensure that all relevant information

is accurately communicated. This kind of communication should be concise in order to

communicate information effectively. Written piece of communication allows

information to be recorded and can be referred to at a later date. A good written report

conveys the necessary information using precise, grammatically correct language,

without using more words than are needed.

Writing style, grammar, vocabulary and clarity make written communication

more effective. Written communication includes books, emails, texts, chats, letters and

documents etc. Written communication is indispensable for formal business

communication and to issue legal instructions. Communication forms that predominantly

use written communication include handbooks, brochures, contracts,

memos, press releases, formal business proposals, and the like. Memos, reports, bulletins,

job descriptions, employee manuals, and electronic mail etc are the types of written

communication used for internal communication. For communicating with external

environment in writing, electronic mail, internet web sites, letters, proposals, telegrams,

faxes, postcards, contracts, advertisements, brochures, and news releases are used. In

written communication message can be revised many times before it is actually sent.

23

Unlike oral/verbal communication, written communication does not bring instant

feedback and it takes more time in composing as compared to word-of-mouth.

Visual communication is also a type of written communication where

communication is done using visual aids such as drawing, graphic design, illustrations,

color, typography and other electronic resources. Visual graphs and charts in many cases

replace written communication. Technological developments have made visual

communication much easier.

2.5.4 Interpersonal Communication. Interpersonal communication is the

process by which people exchange information, feelings, and meaning through verbal and

non-verbal messages. Interpersonal communication has to do with relationships between

people. It is face-to-face interaction and any relationship is primarily created, maintained,

or changed through interpersonal communication. Roloff (1981:30) states that

„Interpersonal communication is a symbolic process by which two people bound together

in a relationship, provide each other with resources or negotiate the exchange of

resources.‟ Scholars define it by distinguishing it from other types of communication

with regard to some criteria, in particular the following:

The number of participants is usually small;

The participants are usually in close physical proximity to one another;

The use of sensory channels,

The participants are usually able to provide immediate feedback.

2.5.5 Types of Communication Based on Purpose and Style. Based on style

there are two main categories of communication and they both bear their own

characteristics. Communication types based on style and purpose are:

2.5.5.1 Formal Communication. While communicating a message,

certain rules, conventions and principles are followed. Formal communication occurs in

formal and official style. Usually professional settings, corporate meetings, conferences

undergo in formal pattern. In formal communication, use of slang and foul language is

avoided and correct pronunciation is required.

24

2.5.5.2 Informal Communication. Informal communication is

established for affiliation with the other members of the society or organization and face-

to-face discussions. It is done using channels that are in contrast with formal

communication channels. It‟s just a casual talk. Informal communication can happen

among friends and family members. Use of slang words and foul language is not

restricted in this kind of communication. It is done orally by using gestures. This kind of

communication does not follow authority lines. In an organization, it helps in finding out

staff grievances as people express more when talking informally. Informal

communication helps in building relationships.

2.6 Models of Communication

2.6.1 De Saussure’s Model of Communication 1916 (speech circuit). Saussure

presented a circular model of communication based on two principles: the first

principle sets forth that communication is a linear process in which two persons

interact in a manner that a message is transmitted from one to another; the second

principle alleges that during the communication process, both participants are

simultaneously active, i.e., communication is an active process in which the

participants can at the same time listen and answer or at least react in some way.

Figure 2.1: Saussure's Model of the Speech Circuit

Accordingly, De Saussure‟s communication mechanisms proceed as follows:

two processes are sketched, the first one that he calls „phonation‟ in which the sender

25

formulates a concept, i.e., a mental sign in his/her mind then shapes an acoustic image to

this concept. The second process, „audition‟, refers to the opposite process in which the

receiver converts the acoustic message into a concept or a mental sign.

2.6.2 Shannon-Weaver Communication Model. Claude Elwood Shannon and

Warren Weaver presented this model in 1949. The Model is specially designing to

develop the effective communication between sender and receiver. Shannon and weaver

found the factors, which affect the communication process called „Noise‟. This model

deals with various concepts like information source, noise, channel, message, receiver,

encode and decode etc. Shannon and Weaver claim that usually the channel is affected by

some external factors, which in turn has some effect on the intended messages.

2.6.2.1 Criticism of Shannon-Weaver model of communication:

This model is more effective in person-to-person communication than group or

mass audience.

The model is based on “Sender and Receiver”. Here sender plays the primary role

and receiver plays the secondary role (receive the information or passive).

Communication is not a one-way process. For example, audience or receiver who

listening a radio, reading the books or watching television is a one-way

communication because absence of feedback.

Understanding noise will help to solve the various problems in communication

Figure 2.2: Shannon and Weaver's information theory model of communication

26

2.6.3 Mole’s Communication Model. An American linguist attempted to design a model

of communication process, which was built on Shannon and Weaver‟s theory of

communication. Mole brought in „code‟ as an essential element for a successful

communication between a sender and a receiver. Moreover, Mole believed that the sender

and the receiver must share a primary set of codes. No matter whether or not they share

the same language, they have to depend upon the words they know in order to get the

message across.

2.6.4 Jakobson’s Model of Communicative Functions. The linguist and

communication theorist Roman Jokobson extends other linguists‟ models and allocates a

communicative function to each element of his communication model. He names six

communicative functions which show how language operates for specific purposes.

The emotive/expressive function deals with the speaker‟s emotional attitude

towards the content of the message.

The conative function focuses on the receiver. It reflects what the sender

expects the receiver to do as a consequence of receiving the message

The referential function refers to the context and explains that any

communication is contextual.

The phatic function refers to the channel of communication.

The metalinguistic function deals with the „code‟. This function is necessary

to check whether the message is clearly understood and provides clarification

and correction when needed.

The poetic function has stress on the form of message. It deals with the

creative use of language by means of prosody and rhetorical figures.

2.6.5 L.E.A.R.N. Model. Berlin and Fowkes presented LEARN Model. This

model suggests that the physicians listen to the patient‟s perception of the problem with

sympathy, explain their own opinion and perception of the problem, acknowledge and

discuss the differences and similarities, recommend treatment options and negotiate an

agreement (Berlin & Fowkes). They believed that LEARN model could be used to help

health care providers overcome communication and cultural barriers.

27

Figure 2.3: The LEARN Model by Berlin and Fowkes

2.6.6 R.I.S.K. Model. Kagawa & Singer presented the RISK model. The

researchers promoted the need for health care providers to identify patient‟s perspective

to avoid pitfall of stereotypes and to ignore the influence of culture. Kagawa and Kassim

offer the RISK approach as,” a way to elicit information about the patient‟s resource,

identity skills, and knowledge”. They believed that the use of RISK Model could help to

create an atmosphere of mutual respect between patient and physician.

2.6.7 A THREE-FUNCTION Model. Cole and Bridge created this model for the

medical interviews between doctor and patient. The basic steps of the Three-Function

Model interview are:

Building relationship and responding appropriately to patient‟s emotions

(relational skills)

Collecting all relevant data to understand patient‟s problem (data-gathering skills)

Educating the patient about his/her illness and motivating her to adhere to

treatment (information-giving skill, negotiating and motivation strategies)

This model is very effective for the physicians working in cross-cultural

conditions.

2.6.8 Patient’s Explanatory Model. Kleimen presented this model. The model

proposes that patient-doctor communication involves negotiation and translation. The

goal of this model is that the physician understands patient‟s perspective of illness, as

28

well as making sure that patient understand diagnosis and treatment recommendations.

Kleimen believes that patients are less likely to follow treatment recommendations when

the recommendations do not conform to cultural belief, values and perspectives.

According to Kleinman et al. “Eliciting the patient‟s explanatory model gives the

physician knowledge of the beliefs the patient holds about illness, the personal and social

meaning he attaches to his disorder, his expectations about what will happen to him and

what the doctor will do, and his own therapeutic goals. Comparison of patient model with

the doctor‟s model enables the clinician to identify major discrepancies that may cause

problems for clinical management. Such comparisons also help the clinician know which

aspect of his explanatory model need clearer exposition to patients, and what sort of

patient‟s education is most appropriate. And they clarify conflicts related to different

levels of knowledge but different values and interest. Part of clinical process involves

negotiations between these explanatory models, once they had been made explicit.”

Kleinman presented a set of questions to be used as a tool for facilitating cross-cultural

communication. Words and number of questions may vary depending upon the

characteristics of the patient, the problem, and the settings. These questions can be:

a. What do you think has caused your problem?

b. Why do you think it started when it did?

c. What do you think your sickness does to you?

d. How severe is your sickness?

e. What kind of treatment you think you should receive?

f. What do you fear most about your sickness?

All these models provide limited cross-cultural education to overcome

communication barriers. In addition, adoption of either Model frameworks requires time

and space in medical curriculum that is already overloaded (Madison, 2002). To build up

healthy relationship with patient, both verbal and nonverbal communications need to be

considered.

29

2.7 Sociolinguistics

Sociolinguistics deals with interaction between language and society. Commonly,

ethnography of communication and interactional sociolinguistics are two common

approaches used by the sociolinguist for the study of workplace discourse. A third

approach which has also gained influence as sociolinguistics has moved towards more

situated interactions research models is the community of practice model.

2.7.1 Ethnography of Communication. The ethnography of communication is

based on anthropology and linguistics; this approach to discourse was developed by Dell

Hymes (1974). The approach seeks to analyze localized patterns of communication as

part of cultural knowledge and behavior and tries to find how and for what purpose

language is used in particular contexts. This approach also explores cultural relativity

and diversity of communicative practices that occur in our societies. Moreover,

this approach emphasizes mainly that the central construct is the notion of

communicative competence. Communicative competence comprises the knowledge

speakers need to communicate appropriately within a particular speech community, and

the skills they need to make use of it (Saville-Troike, 2003:02). Since various researchers

have provided extensive literature on workplace communication with its roots on

culturally and socially bound groups (Sarangi and Roberts, 1999:26), and this approach

remains influential within anthropological linguistics, sociolinguistics and

communication studies more generally. Observational and other ethnographic techniques

are traditionally the main tools used and little attention is paid on direct analysis of

spoken discourse.

2.7.2 Interactional Sociolinguistics. John Gumperz is the most influential

supporter of interactional sociolinguistics. He has similar origins in anthropology,

sociology and sociolinguistics to the ethnography of communication, and shares its

concern with the interaction of culture, society and language (Gumperz and Hymes

1972). Interactional sociolinguistics focuses more explicitly on the social and linguistic

meanings generated during actual interaction; it also draws some principles and analytic

tools of pragmatics and discourse analysis. Participants are observed to make inferences

about one another‟s communicative intentions and goals based on a wide array of verbal

30

and non-verbal contextualization cues that form part of cultural repertoires for signaling

meaning, and which can be discovered only through the analysis of actual utterances

(Schiffrin 1994:12).

Moreover, interactional sociolinguists attempt to “bridge the gap” between top-

down theoretical approaches and conversation analysis which provide a “bottom-up”

social constructivist account by focusing on spoken interaction as “the real world site

where societal and interactive forces merge” (Gumperz 1999:453-4). Previously analysts

had, in the past, been interested mainly in the critical analysis of (problematic) discourse

processes in “strategic” research sites characterized by status and power inequalities

between the participants (Roberts et al; 1992). Archetypal examples include studies of

intercultural interaction (Gumperz , 1982), male-female communication (Tannen 1999),

(inter-ethnic) meetings and interviews in organizational contexts (e.g. Drew and Heritage,

1992; Roberts and Sayers, 1987; Mumby and Clair, 1997), as well as research in other

domains such as medical interactions (e.g. Moss and Roberts, 2005; Hamilton and

Britten, 2006; Dowell et al 2008) and general workplace interaction (e.g. Holmes &

Stubbe, 2003).

2.7.3 Communities of Practice. Community of practice is characterized as “an

aggregate of people who come together around mutual engagement in an endeavor …

defined simultaneously by its membership and by the practice in which that membership

engages” (Eckert and McConnell-Ginet,1992). The practices may include beliefs of

people, values, way of talking and doing things that occur in the course of mutual

endeavor.

Section –III

2.8 Communication Barriers

Communication barriers range from simple noises to the most complex

psychological factors, these barriers may cause slight distractions in communication or

total failure of communication. A communication gap can be bridged but situations

cannot be retrieved. Barriers to effective communication are:

31

Physical/Environmental Barriers

Cultural Barriers

Linguistic Barriers

Attitudinal Barriers

Physiological Barriers

Systematic Barriers

Social Barriers

2.8.1 Language Barriers. Language barriers occur when people use

inappropriate levels of language (too formal or informal). The problem can also occur

when people do not speak same language or have different levels of ability in language.

Sometimes barriers do occur when people speak same language but excessive use of

slangs or jargons in speech make communication difficult.

In healthcare set-ups, use of medical terminology is an easily identifiable

linguistic problem. Margaret Simmons (1998) advocates that for any patient it is difficult

to understand scientific terminology and description of illness and as a result, an effective

communication cannot take place between doctor and patient.

2.8.1.1 Communication & Medical Jargons. A review of studies has revealed

that patients often fail to understand the meaning of common medical terms and jargons

used by the doctors while interacting with the patients. At the same time the doctor

believe that the patient has understood instructions clearly. Others believe that doctors‟

use of medical jargon was linked to preserve their authority at the expense of patient‟s

ability to influence the course of consultations. Not focusing on emotional concerns of

the patient, restricting information and closed interviewing techniques are also considered

as examples of tactics used by the doctors to preserve their authority. Other tactics

developed by the doctors is to translate aspects of their explanation in regional dialects,

but this type of communication can have reverse effect.

2.8.2 Physiological Barriers. Fundamental parts of effective communication are

hearing, seeing and speaking. Thus physiological barrier to communication is the result

of a sensory dysfunction, either on the part of the receiver or the sender. If a person is

32

unable to hear, speak or see, some measures must be taken to provide an alternative

method of communication.

2.8.2.1 Hearing Impairment. Hearing impairment is one of the

physiological barrier; the causes of hearing disorders may include developmental

abnormalities, genetic issues, medical conditions/infections or other environmental

issues. Hearing loss can cause problem in speech and language, social and educational

development of individuals, but it rarely causes developmental problems. Hearing

impairment typically will cause a problem in individuals‟ speech and language, social

development and educational achievement are affected by the condition. This kind of

impairment not only delays an individual‟s communication skills, but also decreases the

amount of effective communication possible with other people.

2.8.2.2 Speech Disorders.

Speech disorder includes different types of disorders such as stuttering, apraxia and

dysarthria. A person suffering from stuttering looses the fluency of communication with

prolonged speech sounds and repetitions of parts or entire words. Apraxia is another

speech disorder, which occurs due to damage to the speaking part of the brain. A person

suffering from Apraxia loses the ability to form syllables and words with sounds. The

severity of disorder depends on severity of the brain damage. Dysarthria is also an

example of speech disorder; a condition in which the muscles of the face, mouth and

respiratory system are weak and are unable to work at full capacity. This condition can be

due to muscular dystrophy, a stroke or cerebral palsy. For a person unable to speak in an

understandable and clear manner, communication will quickly break down.

2.8.2.3 Vision Impairment. Vision impairment is an example of

physiological barrier to communication. The level of impairment differs from person to

person. Vision impairment may result difficulty in noticing details, blind spots, blurring

or sensitivity to bright light. Vision impairment limits the communication for a person in

many ways; a person with vision impairment is unable to see facial expressions and body

language of the person whom he is talking to. Such person may not understand language

33

which is spoken in an unclear manner, and may find understanding conversations

difficult and confusing.

2.8.3 Physical/Environmental Barriers. Time, Place, Space, Climate and Noise

are major physical/environmental barriers. These factors may just cause distraction

leading to inattentiveness or totally alter the message, causing miscommunication.

2.8.3.1 Time. Time has an important role in a communication process.

Everyone has to choose fastest channel of communication with good alternatives, as the

quickness of communication is the watchword in the modern world of communication.

The time lag between countries has to be overcome by the adoption of modern and fast

communication channels.

Moreover, there is need to choose a face-to-face oral communication channel to

give instructions to a worker, a public address system to reach a large member of people

scattered over a large area, a visual signal in crowd management and a courier system to

reach client spread over and at distance and so on. Modern banking through voice

recording systems is also an example of adopting modern means of communication to

utilize time wisely. Social media like Skype, Facebook, twitter etc. are the most modern

form of communication tools that are helpful in overcoming physical barriers like time

and one can reach people sitting in different parts of the world, in a different time zone.

In the modern era, effective fast channels of communication are replacing slow channels

of communication.

2.8.3.2 Space: Space plays an important role in an oral communication

situation. Experts classify an oral communication situation on the basis of the distance

maintained between sender and receiver as Intimate, Personal, official and Public.

Intimate: If the distance between encoder (sender) and decoder (receiver) is less

than a foot and a half (18 inches), the situation is labeled intimate. The mother

coddling the baby, the father and the son, or husband and wife in a familial/

private situation communicate at an intimate level of space.

Personal: Friends and peer groups maintain a distance of about two to three feet

in a process of communication, which is personal.

34

Official: In official situation, the space should be at least four to five feet

depending on the message or information.

Public: The distance between the speaker (the encoder) and the listeners (decoder,

in this context an audience) should be over ten feet, in a public situation.

2.8.3.3 Place: an effective communication can be degenerated due to

barriers of place or the location where communication is taking place. A simple

comparison of surrounding in a Municipal office and ambience provided in a

multinational company will show how place and surrounding plays an important role in

effective communication. Conditions like poor lighting, noisy places, insufficient space

and rickety furniture all are factors that make people irritable and impatient. Good

ambience and suitably lighted and ventilated places promote effective communication.

2.8.3.4 Climate: Unfavorable climate can act as a physical barrier to

communication leading to wrong perception of decisions. Though the word climate refers

to the human relations prevailing there, it is no exaggeration to say that the actual room

temperature helps people to keep their heads cool!

2.8.3.5 Noise: If the surrounding of interlocutors is noisy; good

communication situations cannot be expected. Noise is a physical barrier to effective

communication. Noise can be from external source or may exist in the communication

loop, in both cases effective communication can merely be achieved by shouting.

Effective communication is impossible on the factory floor, the bus stand or railway

station. Noise distorts messages and acts as a barrier to effective communication.

2.8.4 Attitudinal Behaviors. Behaviors or perceptions that prevent employees

from communicating properly come under the heading of attitudinal behaviors. Attitudes

are commonly formed by an individual's opinions on a subject/ person and can be

difficult to alter. When attitudinal barriers override the sense of professionalism in a

workplace, it can become difficult for an individuals or groups to engage in productive

communication.

2.8.4.1 Abstracting. Abstracting can also be referred to as "selective

hearing." Abstracting is actually the attitude that you do not need all of the details to

understand the concept being presented in a conversation and your mind condenses what

35

is being said into an abstract, or a summary. While abstracting, there is a problem that

you may leave out important information because of unawareness of the complete topic.

The person you are speaking to be unaware of what information you are filtering out, and

that can create a breakdown in communication as well.

2.8.4.2 Emotional Editing. Emotional editing is an example of attitudinal

barrier based on individual‟s personal feelings about a person or topic. An example of

emotional editing is that if you were asked to go for a meeting in a country you like to

travel; you would happily go. On the contrary if you do not like a co-worker to work

with; you won‟t enjoy doing a project with such co-workers. Your temper through the

entire project is affected by your emotional dislike of his/her presence in your vicinity;

this is an example of emotional editing.

2.8.4.3 Stereotypes. Stereotyping is an attitude that alters communication

because of a general opinion applied to a particular group. A sexist example of

stereotyping is the misguided notion that women cannot be good drivers. Having

stereotype can make organizational communication very sensitive; it can affect the ability

to deliver a simple message.

2.8.4.4 Prejudice. Prejudice is the act of disliking someone or something

because they belong to a particular group. This attitudinal barrier can be devastating for

organizational communication. For example, the engineering department may not share

information with the marketing group because the engineers have a prejudice against the

marketing people.

2.8.5 Cultural Barriers. When people from different cultures communicate, they

have different ways of thinking, ways of seeing, hearing and interpreting the world; the

difference of attitude to analyze and interpret things is an example of cultural barriers.

Thus the same words can mean different things to people from different cultures, even

when they talk the "same" language. When people from different cultures do not share

same language, they use translations to communicate, the potential for misunderstandings

increases.

36

Stella Ting-Toomey (1999) explains about three ways in which culture interferes

with effective cross-cultural understanding.

Cognitive constraints (frame of reference that provides a backdrop that all

new information is compared to or inserted into)

Behavior constraints (every culture has its own rules about proper behavior

which affect verbal and nonverbal communication)

Emotional constraints (different cultures regulate emotions differently)

All of these differences tend to lead to communication problems. If people are not

aware of the potential for such problems, they are even more likely to be exposed to such

problems, although it takes more than awareness to overcome these problems and

communicate effectively across cultures.

In this globalized world, societies are multicultural and doctors are increasingly

confronted with patients from different cultural backgrounds. The profound evidence of

health care disparities across ethnic and racial lines as well as cultural impressions on

health care practices is too impressive to overlook. A number of studies conducted,

indicate that there is more misunderstanding and less satisfaction in intercultural medical

visits, compared to intra-cultural encounters (Shouten, 2006). It is important that doctors

are able to understand the patients‟ culture; not only difference in dress or diet, but also

about what really matters to people‟s belief, their ethics and values, and their heritage

(Kleinman, 2006). In area of health care, being culturally competent means that health

care provider can deliver effective service to racially, ethnically, and culturally diverse

patient populations (Fernandez, 2004).

2.8.6 Social Barriers. Besides language, physiological, attitudinal and cultural

barriers there are other potential barriers.

Health literacy

Gender

Social class

Length of time in communication

Health literacy of patients is one of the reasons for difficulty in effective

communication between doctors and patients. Health literacy refers to a mismatch

37

between the healthcare providers‟ level of communication and the patients‟ level of

comprehension of the medical information given to them (Weiss, 2003). Gender is yet

another example of social barriers. Researches show that female doctors tend to have

longer visits in partnership building and they are emotionally focused positive talks than

do male doctors. The difference of social class and education can also act as a barrier in

effective communication. Educated patients have ability to understand or receive more

information than patients who are less or uneducated. Waitzkin (1984) found that patients

from upper and upper-middle class receive more information and more multilevel

explanation than did the patient of lower middle-class or lower class background. The

length of time doctors spend also matters for an effective communication and to

overcome the social barriers halting development of positive relationship between doctor

and patients.

2.9 Defining the “Doctor-Patient” Relationship

The doctor-patient relationship is a central process in the practice of medicine.

Talcott Parsons was the first social scientist to theorize the doctor-patient relationship.

According to him, “the physician's role is to represent and communicate (information

about illness) to the patient to control their deviance…with physician and patient being

protected by emotional distance (Hughes,1994). A good doctor and patient should

exchange emotional sentiments in order to build up good connection; Parson‟s view is

contrary to this fact and for him, doctor and patient are being protected by emotional

distance. Modern time physicians believe that the rapport begins when they get

accustomed to patients symptoms and concerns. It is important that doctors become

aware of patients‟ life style and their healthy demeanor (family, habits, beliefs, stress,

work etc.) As knowledge of this, provides fundamental clues to the patient‟s conditions

and further management of the problems. Subsequently, the doctor diagnoses/examines

the patient, interprets symptoms, formulates diagnosis, and suggests treatment and

follow-up plan to which the patient agrees upon. A study by Coulehan & Block (2006)

shows that the doctor-patient relationship concerns can also be analyzed from ethical

perspective; to know how well the goals of beneficence and autonomy and justice are

38

achieved. In diverse societies & cultures, it is very difficult to scrutinize doctor-patient

relationship as different standards are allotted different priorities.

It is certain that good communication between doctor and patient is primary

characteristic, which helps to define how successful the affiliation can occur between the

two individuals. Much of medical practices depend upon collection and management of

accurate information on the basis of which proper diagnosis and prognosis can be done.

In addition, involving patient in treatment planning and eliciting informed consent

requires effective communication between doctor and patient. According to Schyve,

“effective communication is communication that is comprehended by both participants; it

is usually bidirectional between participants, and enables both participants to clarify the

intended message” (Schyve, n.d.). If doctor-patient relationship is lacking trustworthy

relationship, health care proceeds with errors and it can risk patient‟s safety. For example,

without successful communication, the patient may not feel comfortable telling the doctor

every aspect of the problem or how it might relate to his lifestyle choices.

2.9.1 The Doctor-Patient Relationship: a historical perspective. The roles of

doctors and patients have been changing through history. From the fifteenth to the

nineteenth century, medicine operated more like a trade than a profession, with a range of

practitioners available, including physicians, herbalists, wise-women, apothecaries and

midwives (Pelling and Webster, 1979; Porter, 1997). Rich patients shopped around and,

in a social regime dominated by patronage, physicians often deferred to powerful

patients‟ self-diagnosis and preferred treatments (Rivett, 1997; Porter, 2002).

Nineteenth century was the age of discovery in science and lead to reforms in

medical policies and institutions (Porter, 1997); invention of stethoscope, microscope and

discovery of x-rays made diagnosis more systematic; medicine became more objective

and analytic (Lupton, 2003). In twentieth century, physicians had access to a range of

technological aids including thermometers, sphygmomanometers and diagnostic

laboratories, whilst penicillin and other antibiotics brought enormous new therapeutic

power (Porter, 1997); diagnosis and treatment were improved. In early 1950s sociologist

Talcot Parsons examined the social structure of the doctor-patient relationship (Parsons,

1951). The doctors were expected to apply scientific knowledge for recovery of patients

but doctors maintained certain privileges; patients were unable to improve their health on

39

their own without consulting doctors. Poor doctor-patient relationship continued till

1970s; in this period, medicine infiltrated many spheres of life, for example involvement

in normal pregnancy and childbirth and the introduction of screening for babies and

children (Rivett, 1997; Porter, 1997). A study by Glaser and Strauss in 1966 found that

American physicians were reluctant to disclose impending death to their patients, and

nurses were expected not to disclose it without the consent of the responsible physician.

According to Freidson (1971) the medical profession had a “bias toward illness”.

Foucault (1973) suggested that classificatory medicine, in which treatment followed

diagnosis, based on deduction from the evident symptoms, focused on clinical signs

rather than the patient‟s experience of illness. The doctor therefore maintained a

professional distance from the individual patient in order to correctly interpret the signs

of disease, an act in which the patient played no part other than as the site of that disease.

In 1980s, public opinion shifted away from passive acceptance of the doctor‟s advice.

Public mood swung away from unquestioning admiration of science and technology

(Rivett, 1997). Patients‟ rights, such as informed consent, were stressed (Porter, 1997). In

1980s, Ian Kennedy‟s Reith lectures called for a new relationship between doctor and

patient, with people taking greater responsibility for their lives, challenging the power

that doctors exercised over their lives and arguing that: “doctors must be made

accountable to us” (Kennedy, 1981). In modern time, patients are more curious to know

about their health, they communicate with doctor and health care system is trying to

improvise healthcare system to ensure proper diagnosis and prognosis.

A study was designed to assess the effect of language barriers on Spanish-

speaking patients‟ satisfaction with the doctor-patient relationship. It incorporated a

sample of 457 native Spanish-speaking adult patients who went to a Los Angeles medical

center emergency department for primary evaluation of a routine medical problem.

Participants were also asked whether an interpreter was used, and if not, whether they

felt one should have been used. Multivariate analysis showed that using an adhoc

interpreter or reporting that an interpreter was needed but not used were significantly

predictive of lower satisfaction. The other significant independent predictor of satisfaction

was inadequate literacy. Language barriers can negatively influence patients‟ perceptions of

provider care (Baker, Hayes, and Fortier, 1998). Another relevant study was conducted

40

about jargon and medical terminology. In the medical setting, unconsciousness is often a

sign of severity of illness. The objective of this research was to verify the general public‟s

awareness and comprehension of the word “unconscious.” Seven hundred adult patients

attending an inner city accident and emergency department were asked, in English, one of

seven questions regarding the concept of unconsciousness. When the inter-relationships

of all variables were examined via logistic regression analysis, the independent

predictor of supplying a correct answer was having English as a first language. Non-

native English speakers, even when speaking English, may have difficulty understanding

frequently used medical terms (Cooke, Wilson, Cox, and Roalfe 2000).

A survey was administered in English and Spanish to measure the effect of

language barriers on medication use, patient satisfaction and preventive testing in an urban

adult primary care setting in New York. There were no trained interpreters on site, but

bilingual medical office assistants were available to serve as adhoc interpreters. Survey

questions regarding medication instruction and adherence, patient satisfaction and use of

preventive testing allowed responses of “yes” or “no.” Responses were analyzed with chi-

square tests. Language barriers may result in inadequate explanation of medication side

effects and decreased patient satisfaction with care, but may not negatively affect the

likelihood of receiving breast cancer screening (David, and Rhee, 1998).

The gender of the doctor sometimes effect during doctor-patient interaction. The

objective of study was to assess the association of physician gender with patient ratings of

physician care. English-speaking and Spanish-speaking patients were enrolled in the study

while waiting to be seen in a large emergency department in Los Angeles. One week later,

they were interviewed about their satisfaction with the interpersonal aspects of care

provided during that visit. Spanish-speaking men who had interpreters were also

significantly less satisfied than English-speaking men in multiple measures of satisfaction

with physician care; there was no difference between women who had interpreters and

English-speaking women. Use of Interpreter and physician language proficiency may affect

patients‟ satisfaction with physicians slightly difference, depending on patient gender

(Pitkin, Hays, McCaffrey, and Baker, 2001).

Another study examines the association between doctors-patient language

concordance and patient question- asking behavior and patient recall at an internal

41

medicine clinic in New York City. Each patient- doctor encounter was directly observed and

followed by the patient‟s interview. The observer recorded the number and type of questions

asked by the patient and the information given by the doctors. By using t-tests it was found

that patients seen by bilingual doctors had a significantly higher recall than patients seen

by non-Spanish-speaking doctors. Using chi-squared analysis, the number of patients who

asked one or more questions was also significantly higher in the language concordant group.

Language concordance between patients and their doctors may result in better recall

and increased patient efficacy (Seijo, Gomez, and Freidenberg,1991).

The present research is different from the above mentioned researches in some

aspects. The research which was conducted to assess the effect of language barriers on

Spanish-speaking patients‟ satisfaction with the provider-patient relationship indicated

that the role of interpreter was not much needed by the patient. But in the present

research it was much required especially in rural area of district Rawalpindi. They are

considered very helpful in overcoming language as well as cultural barriers and

conveying information of patients to doctors in an effective way. It also helps patient in

their medical treatment procedures which are followed in government hospitals.

Inadequate knowledge regarding disease shared by patient also affects doctor‟s

diagnosis. Another study which was conducted about Jargon and medical terminology

indicated that patients are even unaware of the word “unconscious”. This problem was

also observed in the present study but only in rural areas of district Rawalpindi. The

use of jargon and medical terminology by some doctors also affect communication

between patients and doctors. Specially uneducated patient having low health literacy

are facing serious implications due to excessive use of these jargons. Sometimes they

are confused and become afraid during medical treatment. The study conducted in Los

Angeles regarding gender indicated that physician language proficiency may affect

patients‟ satisfaction with physician slightly different, depending on patients‟ gender.

But in present research, gender of physician is playing a significant role in the

treatment of patient. Gender of doctor is another factor which sometimes affects

communication. It is observed that female patients especially in rural areas prefer to be

checked up by female doctors. Male doctors are a sort of strict in nature as compared to

female, whereas, females are more caring and affectionate in handling even with male

42

patients. The study conducted in New York City found that bilingual doctors had a

significant importance while examining patients. But in the present research it was

observed that local doctors are successful in dealing the patients. Privacy of patients

during medical treatment or consultation is very essential. The situation in developing

countries is very good but in Pakistan it needs to be improved. In government hospitals

majority of patient are checked up in front of so many patients. Which sometimes

create a very complex and difficult situation for patients to disclose complete

information of their diseases. The setting and location also affects communication

between patient and doctor. Patients feel comfortable if location of their consultation is

safe and secure. Time (length of consultation) is also a significant factor which creates

miscommunication between doctor and patient. If time is limited then less information

are shared and diagnosis is also minimum. In government hospital due to large number

of patients an average 15-20 seconds usually given to each patient for sharing

information. Personality of doctors also gives birth to miscommunication. Rigid and

strict personality becomes big hurdle in communication. Patients rarely ask questions or

share information with such doctors.

2.10 Summary

The related literature was discussed in detail in this chapter. The review was

divided into three sections. Section I dealt with the literature on communication, which

included definition, concept, explanation and its elements. Communication process was

also discussed with relationship to language. Miscommunication at workplace was also

mentioned in this section. Section II started by discussing various types of

communication. Eight models related to communication were also discussed in detail.

Ethnography of communication was also part of this section. Section III contained

literature on communication barriers. It started from general barriers of communication

and ended on specific communication barriers in medical setting. This section also

presented literature on doctor-patient relationship, its significance and scope. The Chapter

concluded with previous researches on the same issue.

The next chapter deals with research methodology.

43

CHAPTER III

RESEARCH METHODOLOGY

This chapter explains methods used in carrying out this research and presents the

statistical tools used for the study. It is an attempt to justify the particular statistical tools

and the method adopted for the collection of data. The study sample, the construction and

structure of the questionnaire, the purpose of methods used in this study and the

techniques employed in data analysis as well as interpretation have been discussed.

3.1 Type of Research

This study was conducted following both quantitative and qualitative approaches,

which is named as Mixed Method Approach. Quantitative studies are used for collecting

large-scale data from a vast area. It implies using numerical data as the evidence based.

Since numerical data is collected, analyzed by using statistical procedures, conclusions

are drawn on the basis of this analysis. On the other hand, qualitative studies are used for

a deep insight and elaborate understanding of a limited phenomenon through collection of

almost exhaustive information or data (Gay et al., 2009). Thus in case a study involves a

large area and a range of phenomena then in view of feasibility regarding time limitations

and the large size of data close ended questionnaires are used which save time and effort.

Mixed methods research approach is growing in importance nowadays because

combining methods reinforce each other. This approach, furthermore, produces

understanding with deep insight over a large population. The present research is mainly a

descriptive study, which aims to describe the existing situation of communication

between doctor and patient.

3.2 Design of the Study

Research design is the overall arrangement of linking theoretical research

problems to relevant and realistic empirical research (Ghauri & Gronhaug, 2005). It is

44

also useful for researcher to make rational choices and prioritize the preferred method of

collecting and analyzing research data. However, Saunders et al (2007) describe the

research design as a general plan that shows how the researcher answers the research

question or problem. Survey strategy has the benefit of collecting large amount of data

from sizeable population in economical way. Survey is observed to be trustworthy by

people in general and surveys are comparatively easy to explain and understand. The

survey strategy is helpful in collecting quantitative data that is used to analyze

quantitatively using descriptive and inferential data statistics. Survey strategy can be used

for possible reason to know the particular relationship between variables and to create

model for their relationship. Survey strategy gives more control over the research process

in sampling; it generates the findings that are representative of the whole population at

lower cost by collecting the data for whole population.

This research is survey research in which data was collected from district

Rawalpindi of Punjab province in Pakistan by using questionnaires and interviews as

research tools. Fifty questionnaires were distributed among doctors in eight Tehsils

(administrative sub-division within the jurisdictions of a district) of district Rawalpindi. It

was preferred that the questionnaires be filled by the doctors of government hospitals

from the urban and rural areas of eight Tehsils. Most of the districts headquarter

hospitals, tehsils headquarter hospitals, rural health centers, basic health units and

government rural dispensaries were visited by the researcher himself in order to distribute

questionnaires and to conduct interviews. Two hundred and forty three doctors had filled

the questionnaires out of four hundred distributed. For interviews the researcher met

each patient in person and conducted a strictly structured interview and its justification

has been provided in instrumentation. All the patients were found to be very cooperative

but hesitant at the same time to be interviewed in English. Three patients from each

tehsil were interviewed. Twenty four interviews in total were taken from eight tehsils of

district Rawalpindi.

3.3 Theoretical Framework

Theoretical grounding for this study was derived from the conceptual model of

Miller (2002), who introduced this model to guide research, investigating the relationship

45

between doctors-patient communications. This model posits that patient, doctor, and

contextual characteristics influence the nature and content of doctor-patient medical

discourse, all of which, in turn, affects various health outcomes. How this process

unfolds, however, depends, in part, on the medium through which consultation takes

place, whether in-person, over the telephone, via fax or email, or through two-way

interactive video.

3.3.1 Patient’s Characteristics. Communication researchers have identified a

number of patient‟s characteristics that influence how doctor and patient communicate

with each other. Patient characteristics commonly shown to influence medical

communication behavior include: age, gender, social class (typically measured using

income, education, or occupational status) and health status (e.g., severity of illness, level

of disability).

3.3.2 Doctor’s Characteristics. Communication researchers have identified a

number of doctor‟s characteristics that influence how doctors and patients communicate

with one another. Doctor‟s characteristics commonly shown to influence medical

encounter communication include: age, gender, social class and specialty/practice

experience.

3.3.3 Contextual Characteristics. Most extant research examines the impact of

patient and doctor characteristics on the nature and content of doctor -patient

communication. Most commonly studied, are: number of participating actors, length of

acquaintance, and type of practice. Other potentially important contextual elements

include culture, geographic location (urban, rural, suburban) and clinical setting (hospital,

physician‟s office or clinic, patient‟s home, nursing home).

3.3.4 Consultation Medium. So far, available research evidence supports the

notion that patient, doctor, and contextual characteristics influence the nature and content

of doctor-patient medical discourse, which, in turn, affects various health outcomes. But

how this process unfolds, depends, in part, on the medium through which medical

consultation occurs. Most extant research examines doctor-patient behavior during face-

46

to-face encounters. Other mediums such as e-mail, secure electronic messaging, and two-

way interactive videos are becoming increasingly important, however, both as

supplements to conventional encounters and as potential substitutes.

This model was based on various characteristics of doctors and patients, which on

theoretical basis have important role in communication endorsed by continuous

researches conducted for a period of more than half a century. These characteristics could

be placed under two broader factors, which are as follows:

A. Linguistic Factors

1. Language

2. Doctors‟ training in communication

3. Speaking proficiency

4. Listening comprehension

5. Jargon/Medical terminology

B. Social Factors

1. Gender

2. Personality

3. Location and setting

4. Time

5. Education

3.4 Sampling

The primary purpose of research is not only to discover principles that have

universal application, but also to study a whole population to arrive at generalization that

is usually impracticable. Some population is so large that their characteristics cannot be

measured. Sample is the subset of the population of interest. Sampling is the process of

selecting members/elements from the entire population in such a way that the smaller

group of individuals represents the characteristics of larger group (population) from

which they are selected. In other words, a sample is a small proportion of a population

selected for study and analysis. In such characteristics of the sample one can make certain

inferences about the characteristics of the population from which sample is drawn.

47

The population for this study comprised of eight tehsils of district Rawalpindi.

District Rawalpindi takes its name from its headquarter town “Rawalpindi” which means

abode of Rawals, a jogi tribe. This district is situated in the northwestern part of Pakistan.

It is bounded on the north by Islamabad Capital territory, Abbotabad and Haripur districts

of KPK, on the south by Chakwal and Jhelum districts and on the west by Attock district.

The total area of the district is 5286 square kilometers. The district is divided into eight

tehsil. They are as follows:

Gujar Khan

Kahuta

Kallar Syedan

Kotli Sattian

Murree

Potohar Town

Rawal Town

Taxila.

Figure 3.1: Map of Rawalpindi city showing eight tehsils.

In this way, all eight tehsils of district Rawalpindi were selected for survey. It was

to assure the representativeness of the sample to an optimal level. From each tehsil,

48

government hospitals (rural and urban) were selected to get true representation of

population. So, mainly the technique of convenience sampling was employed in this

study. Ultimately, the questionnaires were distributed among the doctors on the basis of

their availability and willingness to participate. The focus was that at least thirty-five

doctors should fill the questionnaire from each tehsil, in this way making the expected

sample size of the doctors to be 280. In case of patients, the minimum number to be

interviewed was three from each of the selected tehsils. The table below shows detail of

the distribution of questionnaires in eight tehsils.

Table 3.1: Tehsil wise distribution of the number of questionnaires

Sr.

No

Name of Tehsil

Total Questionnaires

Distributed

Total

Questionnaires got

filled

1 Gujar Khan

50 32

2 Kahuta

50 34

3 Kallar Syedan

50 27

4 Kotli Sattian

50 25

5 Murree 50 30

6 Potohar Town 50 39

7 Rawal Town

50 38

8 Taxila

50 18

Total 400 243

49

3.5 Instrumentation

Instrumentation is the process of selection or preparation of instrument to collect

relevant data from the selected setting. It is one of the core activities in any research

study for the quality of instrument in terms of its suitability, reliability and validity

decides about the quality of research. Instruments are either selected from the already

existing instruments, or adapted from them or created a new by the researcher in case if

either of the formers do not work or cannot be applied (Gay et al., 2009). A questionnaire

was developed under the guidance of supervisor. Detail procedure for construction is

mentioned below.

3.5.1. Construction of Questionnaire. A questionnaire is a planned and written

set of questions related to an area of interest. It is a device consisting of series of

questions dealing with some topic, given to individuals with an object of obtaining

information/data with regard to some problems under investigation. In a questionnaire

open spaces and /or closely related alternatives are provided for indicating the response to

each question. Questionnaire is an economic and efficient method of data collection.

Questionnaire, as a research tool, is the most popular, widely used and easy mean to

collect data. A questionnaire can be directly administered on an individual or group of

individuals or it can be mailed when the target sample cannot be contacted personally.

When a questionnaire is administered personally, the person administering the tool has an

opportunity to establish rapport with the respondent, to explain the purpose of the study,

and to explain the meanings of the questions.

The instrument for this study was a questionnaire, which was adapted from the

conceptual model of Miller (2002), who introduced this model to guide research

investigating the relationship between doctors-patient communications. A questionnaire

was constructed for doctors working in government hospitals. This questionnaire was

divided into four parts. Part A included demographic information about doctors. Part B

contained such statements, which reflected the linguistics barriers in doctor–patient

communication. Part C contained social factors, which become hindrance in

communication between doctor and patient. Part D contained open-ended questions for

doctors‟ opinion to improve their relationship and reduce miscommunication with

50

patients. The questionnaire had 55 close-ended items having five point Likert scale (was

suggested by Gardner, 2010) options to respond to the given statements which ranged

from strongly agree to strongly disagree while there being agree, uncertain, and disagree

in between these extreme points.

3.5.2 Piloting Questionnaire and Reliability. The questionnaire was

designed and was piloted on a sample of 30 doctors from tehsils of Potohar and Rawal

towns. The sample was convenience based. Cronbach Alpha was found for reliability test

of the questionnaire. Overall Alpha value of the questionnaire used for pilot study was

found to be 0.795, which is quite high. Coefficients of the sub-scales designed to measure

respective constructs were also measured which were different. Alpha values of the sub-

scales are given below.

Table 3.2: Cronbach Alpha values of subscales of the questionnaire

Construct Cronbach’s Alpha

Language

0.830

Doctors‟ training in

communication

0.785

Speaking proficiency

0.682

Listening comprehension

0.671

Jargon/Medical terminology

0.776

Gender

0.732

Personality

0.544

Location and setting

Time

Education

0.804

0.457

0.688

It can be seen that alpha values for nine out of ten subscales are very high. Only

one sub-scales i-e time has low value but it does not affect the overall reliability of the

51

questionnaire. Besides questionnaire as a tool, an interview schedule for patients was also

designed and conducted. The detail of structuring of an interview is given below.

3.5.3 Designing and Conducting the Interviews. The interview is probably the

man‟s oldest and most often used method for obtaining information. It is a face-to-face

interpersonal situation in which an interviewer asks a person being interviewed, the

respondent or interviewee, the questions designed to obtain answers pertinent to the

research problems. In a face-to-face meeting, an interviewer can constantly encourage the

interviewees and can probe more deeply into various variables. Through interviewee‟s

incidental comments, facial and body language or expressions, and tone of voice, one can

acquire information that cannot be conveyed in written replies. The auditory and visual

clues also help to keep the tempo of the tone of the private conversation, so as to elicit

personal and confidential information and to gain knowledge about feelings, attitudes and

beliefs.

Strictly structured interviews were designed for this research. It was done in view

of the problems that patients of the hospitals could face in unstructured discussions due to

their lack of proficiency and practice in oral communication through English. It was

found in a couple of pilot interviews that the participants either refused or preferred to

know questions in advance. They reported to be most comfortable if they were allowed to

pen down a rough sketch of their answers and their preference was respected. The

interviews were conducted at daytime when patients were sitting in waiting area for

medical examination. The doctors contacted patients to facilitate their meetings with the

researcher. All the interviews were arranged at the government hospitals of selected

tehsils of district Rawalpindi. Eight questions were carefully selected for the interview; it

includes such questions, which would help in knowing factors for miscommunication

between doctor-patient interactions. The questions included in the interviews dealt with

different factors related to communication barriers as given in the designed questionnaire.

The interview included the issues listed below:

1. Language as a barrier in doctor-patient medical discourse

2. Importance of doctors‟ training in communication

3. Speaking proficiency of doctors

52

4. Listening comprehension

5. Jargon/medical terminology as a barrier in doctor-patient medical discourse

6. Role of gender in doctor-patient medical discourse

7. Impact of doctor‟s personality in doctor-patient medical discourse

8. Importance of setting and location in doctor-patient medical discourse

9. Role of time in doctor-patient communication

10. Low health literacy of patients (level of education)

3.6 Analysis and Interpretation of Data

A research study produces a mass of raw data. The data obtained from

administration of one or more standardized tools or self-developed instruments or from

available sources is then subjected to analysis. In order to arrive at some answer to

research question or conclusion, the researcher needs to organize data (editing, coding,

classification, tabulation and data entry), analyse data (statistical calculations, reliability

and validity of data, special statistical models to test hypothesis) and interpret it.

3.6.1 Organization of Data. The organization of data includes editing, coding,

classifying and tabulating the data. Editing is a process of examining the collected raw

data to find out errors and omissions, if any, and to correct it, if possible. So it is a

process of careful scrutiny of the responses obtained through questionnaires, interviews,

tests, and observations. It also ensures that data have been well organized to facilitate

coding and tabulation. Editing can be done just at the time of data collection, after

receiving a questionnaire from the respondent. The researcher has done editing of

questionnaires and found that only ten questionnaires respondents have left some

questions as blank. So all these questionnaires were discarded on the spot and were not

included for data analysis. Coding is a process by which the researchers assign numerals

or symbols to answers so that responses can be put into a limited number of groups and

ranges. Coding is required when there are many items in a questionnaire. The researcher

has done coding of the questionnaire as:

53

Table 3.3: Part-A: Demographic Information

Sr. No Item Variable Code

1 C Sex Male=1

Female=2

2 D Age 21-25 years=1

26-30 years =2

31-35 years=3

More than 35 years=4

3 E Marital status Single=1

Married=2

4 H Professional experience 01-05 years=1

06-10 years=2

11-15 years=3

More than 16 years=4

5 I Job Designation Permanent/regular=1

Contract=2

Visiting=3

Others=4

Table 3.4: Part-B: Linguistic Factors

Sr.

No

Construct

Statements in Questionnaire

Code

6 Language 1. Language i s the predominant i n s t r u m e n t

by which information is transmitted between

doctors and patients.

LF1

2. Doctors should have the ability to communicate in

various languages.

LF2

3. Doctors' choice of words affects communication

skills.

LF3

4. Doctors should explain information about disease

and medicine to their patients in detail.

LF4

5. Language barriers are faced by doctors in

communicating with patients.

LF5

6. Language barriers occur when people do not

speak the same language.

LF6

7. Language barriers reduce patient‟s abilities to

follow instructions and adhere to treatments.

LF7

8. Language differences can create an obstacle to

effective interaction between doctors and patients.

LF8

9. Using visuals (photographs, drawings, diagrams)

can help to overcome language barriers.

LF9

10. Nonverbal expressions also contribute to LF10

54

effective communication.

7 Doctors‟

training in

Communication

11. Doctors‟ training in communication skills should

be mandatory for medical profession.

DT11

12. Doctors' training in communication affects

doctor-patient communication.

DT12

13. Successful medical encounters require effective

communication skills between the patient and the

doctor.

DT13

14. Non opening of the discussion is due to lack of

communication training.

DT14

15. Gathering and sharing information ability is due

to communication training.

DT15

16. Understanding the patient's perspective is due to


DT16

17. Provision of closure in interaction is due to


DT17

8 Speaking

proficiency

18. The spoken language is the most important

tool of communication in m e d i c i n e .

SP18

19. The accent of speech used by the doctor also

affects the patient's comprehension of the doctor‟s

communication.

SP19

20. Patients often have trouble in understanding

doctors because he/she speaks too fast.

SP20

21. Verbal expression (tone, pitch) of the patient

effects decision of continuing the communication.

SP21

22. The quality of doctors‟ voice is also important

for clear communication.

SP22

9 Listening

Comprehension

23. Listening attentively creates a partnership

between doctor and patient.

LC23

24. Doctor‟s disinclination to listen to the patient

affects the quality of doctor-patient communication.

LC24

. 25. Preoccupations such as eating, drinking or doing

handiwork divide attention which mars the listening.

LC25

26. Poor hearing of patients is a barrier to effective

listening for doctors.

LC26

10 Jargon/

Medical

terminology

27. The medical terminology used by doctor‟s act as

a barrier in doctor-patient communication.

JT27

28. Patients often fail to understand the meaning of

jargon.

JT28

29. Jargon acts as harmful indicator for medical

55

treatment of a patient. JT29

30. The medical terminology creates

miscommunication if used frequently.

JT30

Table 3.5: Part-C: Social Factors

Sr.

No

Construct

Statement in Questionnaire

Code

11 Gender 31. Gender affects communication between doctor

and patient.

G31

32. Female doctors are more caring and facilitate

more dialogue between the patient and the doctor.

G32

33. Female doctors prefer a more personal, close

setting for communicating.

G33

34. Female patients ask more questions than male

patients.

G34

35. Male doctors spend more time in interviewing

female patients than male patients.

G35

12 Personality 36. Doctors don't communicate well due to their

personality.

P36

37. Doctors need to be more kind, gentle, considerate,

courteous, and respectful to patients.

P37

38. Doctors scold their patient during

treatment/counseling.

P38

39. Negative attitude (rudeness, arrogance) of

patient is a big hurdle in effective communication.

P39

40. Greeting by the doctors makes patient feel

comfortable.

P40

41. Doctors encourage patients to ask questions. P41

13 Location and

Setting

42. The noisy environment makes communication

difficult.

LS42

43. The compatibility of setting (temperature, seating

arrangement, surrounding audience) is a significant

factor in communication.

LS43

44. Comfortable and relax location promote

communication between doctor and patient.

LS44

45. The level of privacy afforded by the setting in

which the doctor-patient interaction occurs also affect

doctor-patient communication.

LS45

14 Time 46. The doctors‟ contact time with patients affect

communication.

T46

47. Communicative style of the doctor (whether

positive or negative) was not affected by the length of

the interaction.

T47

48. The length of time available for the consultation T48

56

affects the nature of the discussion.

49. Waiting time for physical examination is long for

patients which affect their communication.

T49

50. Doctors get enough time for each individual

patient as far as examination is concerned.

T50

15 Education 51. The level of education of patient is prominent

factor in effective communication.

ED51

52. Low health literacy of the patient affects

communication.

ED52

53. Doctors feel uncomfortable while

communicating with a patient whose intellectual

level is lower.

ED53

54. Patients' ability to explain their conditions

(complaints and symptoms) to the doctor is a factor

that also impacts the quality of doctor-patient

communication.

ED54

55. Doctors should try to communicate at the hearer‟s

level of conceptualization to ensure understanding by

the patient.

ED55

Normally the data collection can be of two types i.e. primary and secondary. In

this study both primary and secondary data collection methods were used. Primary data is

the source of information, which provides the original and more specific data in order to

resolve the research problem. According to Saunders et al. (2009: 256) primary data is

collecting a new data specifically for a purpose. Sekaran (2003:220) describe primary

data as the information collected for the first time by researcher on the variables of

research. Primary data can be collected through the source of doing experiment, surveys,

interviews and observation. Secondary data is collecting information from the existing

source or data collected from different internal and external sources (Ghauri & Gronhog,

2005). According to Saunders et al (2009), the data that have already been collected for

some other purpose is called secondary data.

The secondary data is collected through different reliable and appropriate books,

journal articles, case studies and websites from database in order to effectively answer

research questions. In this study, primary data were collected through a questionnaire for

doctors and interviews with patients. During collection of the secondary data,

researcher‟s sources were books and articles.

57

Data analysis refers to the process of organizing material in order to reach at the

findings. The data are studied to find out hidden facts from different dimensions to

explore the new facts. SPSS version 21.0 was used for the analysis of quantitative data.

The version of statistical package was the latest available. For the analysis of qualitative

data gathered through interviews, technique of thematic analysis was used. The answers

provided by the participants were studied and important themes were identified. The

emerging themes were classified under different labels, which were used later on for the

sake of findings and interpretations. Interviews were also put to thematic analysis. The

responses were critically interpreted in the light of theories followed and the context of

the study.

3.7 Summary

The chapter started by explaining the type and design of the research. Theoretical

Framework was discussed by mentioning its four characteristics; Patient‟s

Characteristics, Doctor‟s Characteristics, Contextual Characteristics and Consultation

Medium. Both quantitative and qualitative approaches were used in it. Quantitative data

were gathered through a questionnaire designed on the basis of a conceptual model given

by Miller while qualitative data were collected through structured interviews with the

patients. Technique of convenience sampling was followed in the selection of the sample.

Different steps were involved in this process, first of all the tehsils of district Rawalpindi

were selected. Doctors who were available and willing to participate were given the

questionnaires. Interviews were also conducted following the same principle. Ultimately,

gathered data was analyzed through SPSS version 21.0. For the analysis of the interview

data, the technique of thematic categorization and labeling was used for significant

findings.

The next chapter deals with data presentation and analysis.

58

CHAPTER IV

DATA PRESENTATION AND ANALYSIS

This chapter deals with presentation, analysis, and interpretation of the data

collected for the study. It has been divided into five main parts. The first part contained

analysis of data gathered through demographic information in the questionnaire

responded by doctors. The second part included analysis of data gathered through close-

ended questions in the questionnaire responded by doctors. The third part consisted of

analysis of data gathered through open-ended questions. The fourth part included analysis

of the data collected through interviews taken from patients and the fifth part described

the analysis of observation during doctor-patient medical discourse. For this purpose, one

questionnaire was constructed for doctors. It contained fifty five closed ended statements

and two open ended questions. The questionnaire was constructed on five-point scale, i.e.

each statement consisted of a five-response categories: strongly agree, agree, uncertain,

disagree, and strongly disagree. The number allotted to each response was 5,4,3,2, and 1

respectively. The structured interview from patients and observation for doctor-patient

medical discourse was also conducted. Analysis of data gathered through close-ended

items was further divided into two parts.

1. Frequency and percentage analysis of data collected on each item separately to

see variation on the basis of three demographic factors i.e. sex, marital status, and

professional experience.

2. Construct wise analysis of data showing in percent the number of the respondents

with high, medium and low level of intensity with each construct.

59

4.1 Part-I: Analysis of Demographic Information of Doctors

Table 4.1: Sex (Demographic information of Doctors)

Frequency Percent Valid Percent Cumulative Percent

Valid

Male 141 58.0 58.0 58.0

Female 102 42.0 42.0 100.0

Total 243 100.0 100.0

The table 4.1 shows that the sample size used for this study to fill the close-ended

questionnaire was 243. The male participants were 141, which make them 58% of the

total sample size while females were only 102 with the percentage as 42 % of the total

sample. The above table indicates that almost equal percentage of both male and female

doctors participated in this research. This gives an approximately even feedback for this

research. It also represents two opposite sex, which generalizes the result for the whole

population.

Table 4.2: Age (Demographic information of Doctors)

Frequency Percent Valid Percent Cumulative

Percent

Valid

21-25years 45 18.5 18.5 18.5

26-30years 60 24.7 24.7 43.2

31-35years 51 21.0 21.0 64.2

More than

35 years

87 35.8 35.8 100.0

Total 243 100.0 100.0

The above table provides the details about age group of participants. Total sample

size used for this research was 243 as shown in table 4.1. The sample has been divided

into four age groups. Group 1 (21-25 years old) had 45 participants, group 2 (26-30 years

old) 60 participants, group 3 having age limit between 31-35, had 51 participants and last

group had 87 participants which are above the age of 35. Every age group had

participants of both genders. Table 4.2 shows the frequency of different age groups in the

sample and maximum participants of the sample belong to group 4 having participants

with age above 35.

60

Table 4.3: Marital Status (Demographic information of Doctors)


Percent

Valid

Single 81 33.3 33.3 33.3

Married 162 66.7 66.7 100.0

Total 243 100.0 100.0

Marital status of the participants is shown in table 4.3; the number of single

participants is 81 in the sample out of 243, which makes 33 percent of the sample. 162

participants of the research are married and make 67 percent of the sample size. Majority

of the participants who were part of this research are married. The marital status includes

frequency and percentages of married and single people.

Table 4.4: Professional Experience (Demographic information of Doctors)


Percent

Valid

1-5years 95 39.1 39.1 39.1

6-10years 53 21.8 21.8 60.9

11-15years 22 9.1 9.1 70.0

Above 16 years 73 30.0 30.0 100.0

Total 243 100.0 100.0

The above table shows the professional experience of the participants of present

research. This research has divided participants into four groups for convenience. The

first group has doctors with 1-5 years of experience, the second group has doctors having

6-10 years of professional experience, the third group is comprised of people having 11-

15 years of experience and the fourth group has doctor participants of both genders

having professional experience of more than 16 years. Table 4.4 shows that sample

contain maximum percentage of professionals having 1-5 years of experience.

61

Table 4.5: Job Designation (Demographic information of Doctors)

Frequency Percent Valid Percent Cumulative Percent

Valid

Permanent 122 50.2 50.2 50.2

Contract 91 37.4 37.4 87.7

Visiting 9 3.7 3.7 91.4

Others 21 8.6 8.6 100.0

Total 243 100.0 100.0

Table 4.5 provides data about job designation of the doctors in this research. Out

of 243, 122 doctors have permanent status job, 91 professionals are on contract jobs, 9

are working as visiting faculty and there are 21 professionals come under „other‟ category

which may include people having their own clinics etc. Permanent doctors make up 50

% of the doctors sample, second major category of professionals is of contract doctors

and least percentage of visiting doctors can be seen in above table.

4.2 Part – II Analysis of Close-Ended Questions Responded by

Doctors

The purpose of analysis in this part was to look at micro-level into the constructs

in order to find any systematic variation among different groups of the participants

divided as such on the basis of following three factors;

A. Sex

B. Marital Status

C. Professional Experience

Mostly sums of the percentages in different response categories have been used in

description of the numeric data. As the scale was 5-point Likert wherein neutral point

was found at point 3 in the scale while all the two positive response categories of high

and low intensity came on 1, and 2 points in the scale respectively. On the other side,

two categories of negative responses with high and low intensity stood at points 5 and 4

respectively. In the description of relative value of each response category against others,

values in response categories of high intensity were given higher weightage over the

62

categories of low intensity. Chi-square has been used to know the significance of the

differences on the bases of demographic factors. Significance of chi-square depends on

Asymp. Sig. (2-sided) value. The level of significance differs with its value as under;

i. > .10 is insignificant

ii. > .05 and < .10 is significant to * (Significant)

iii. > .01 and < .05 is significant to ** (Highly significant)

iv. < .01 is significant to *** (Highly significant)

4.2.1 Single Item Analysis

I. Language (LF1-LF10)

Table 4.6:

Sex-based variation in the responses to Questionnaire item 1

(Language i s the predominant i n s t r u m e n t by which information is

transmitted between doctors and patients)

Key Strongly

Agree

Agree Uncertain Disagree Strongly

Disagree

Total

Frequency 184 45 9 5 0 243

Male 44.4% 11.5% 1.2% 0.8% 0 58.0%

Female 31.3% 7.0% 2.5% 1.2% 0% 42.0%

Total 75.7% 18.5% 3.7% 2.1% 0% 100.0%

Chi-square = 3.279 Asymp. Sig. (2-sided) = .351

Table 4.6 shows results of single item analysis of language category and the

variation in results is sex-based. There were two sexes i.e. male and females were

involved, in response to statement 1, male participants show maximum positive

responses. 56 % of the male participants agree with the statement and 1 % males disagree

with the statement provided in LF1. Agreement and disagreement ratios of females are 38

% and 2 % respectively. The chi value tells that the results of LF1 are insignificant.

63

Table 4.7:

Marital status -based variation in the responses to Questionnaire item 1



Key Strongly

Agree


Disagree

Total

Frequency 184 45 9 5 0 243

Single 23.0% 8.2% 1.2% 0.8% 0 33.3%

Married 52.7% 10.3% 2.5% 1.2% 0% 66.7%

Total 75.7% 18.5% 3.7% 2.1% 0% 100.0%


Table 4.7 shows responses of participants to LF1, the statistics are based on

marital status of the participants. Greater numbers of married participants agree with the

statement as compared to single. In case of negative responses to the statement only 1.2%

of married people do not agree whereas in single this percentage is only 0.8%. The chi-

square results appear to be insignificant as chi value is only 3.296.

Table 4.8:

Professional experience -based variation in the responses to Questionnaire item 1



Key Strongly

Agree


Disagree

Total

Frequency 184 45 9 5 0 243

1-5 years 26.7% 9.1% 1.2% 2.1% 0.0% 39.1%

6-10 years 17.7% 4.1% 0.0% 0.0% 0.0% 21.8%

11-15 yrs 6.6% 0.0% 2.5% 0.0% 0.0% 9.1%

More than

16 years

24.7% 5.3% 0.0% 0.0% 0.0% 30.0%

Total 75.7% 18.5% 3.7% 2.1% 0.0% 100%


64

Table 4.8 has the LF1 responses of participating professionals belonging to

different groups. Professionals belonging to group 4 show the highest percentage of

positive responses, the professionals of group 1 show maximum percentage of

disagreement. Professionals of group 3 show maximum percentage of neutral responses.

The difference in responses of different group of professionals is highly significant and

the chi value is 52.304.

Discussion (LF 1):

The majority of participants agree to the statement that the language is

predominant instrument by which information can be transmitted. In positive response to

the given statement gender difference and marital status of the participants remains

unimportant however professional experience-based variation is highly significant.

Greater percentage of males has shown strongly positive and moderately positive

responses as compared to females. The percentage of neutral responses is insignificant. In

case of negative responses, females have shown greater percentage of responses as

compared to males. The difference in responses of married and single participants is

insignificant. Married participants have greater percentage of positive responses, as

compared to single participants but the difference of these responses is insignificant.

Same difference can be observed in case of negative responses where single participants

have greater percentage of negative responses. Highest percentage of strongly positive

response is from participants who have professional experience of more than 16 years

while moderately positive response is highest by those who have 1-5 year experience. So

responses show a relationship with the professional experience of the participants. Thus

professional experience has emerged as a significant indicator of interest to know that

language is a predominant tool for transmission of information.

65

Table 4.9:


(Doctors should have the ability to communicate in various languages)

Key Strongly

Agree


Disagree

Total

Frequency 68 112 38 10 15 243

Male 18.9% 23.5% 9.5% 2.1% 4.1% 58.0%

Female 9.1% 22.6% 6.2% 2.1% 2.1% 42.0%

Total 28.0% 46.1% 15.6% 4.1% 6.2% 100.0%


Statistics of LF2 responses is shown in table 4.9. The variation of responses is

based on sex. Observing the agreement results research found that 32 percent of females

agree with the statement, in men this percentage is 42. The difference is agreement

percentage is insignificant. Higher percentage of disagreement is shown by the males that

are 6 percent; in females this percentage is 4 percent only. Overall variation of responses

is insignificant.

Table 4.10:

Marital status -based variation in the responses to Questionnaire item 2 (Doctors

should have the ability to communicate in various languages)

Key Strongly

Agree


Disagree

Total

Frequency 68 112 38 10 15 243

Single 8.2% 16.5% 7.8% 0.0% 0.8% 33.3%

Married 19.8% 29.6% 7.8% 4.1% 5.3% 66.7%

Total 28.0% 46.1% 15.6% 4.1% 6.2% 100.0%


66

Table 4.10 has the statistical data of LF2 based on marital-status variation. Total

49 % of the married participants agree with the statement and in singles this percentage

is 25 %. The difference in the responses of married and single participants is significant.

Table 4.11:


(Doctors should have the ability to communicate in various languages)

Key Strongly

Agree


Disagree

Total

Frequency 68 112 38 10 15 243

1-5 years 6.2% 18.9% 7.8% 4.1% 2.1% 39.1%

6-10 years 6.2% 5.8% 5.8% 0.0% 4.1% 21.8%

11-15 yrs 4.1% 4.9% 0.0% 0.0% 0.0% 9.1%

More than

16 years

6.2% 18.9% 7.8% 0.0% 0.0% 30.0%

Total 28.0% 46.1% 15.6% 4.1% 6.2% 100%


Table 4.11 contains statistics of professionals having varied experience. The

professionals of group 3 give 9 percent positive responses. 25 percent of group 1

participants, 12 percent of group 2 participants and 25 % of group 4 participant also agree

with the statement in LF 2. The difference in responses of different professional groups

is highly significant with chi-square values of 63.908.

Discussion (LF 2):

In response to LF2 the percentage of positive responses is significantly high. In

positive or negative responses gender difference remains unimportant; moreover, the

percentage of neutral responses is not very significant. However, in positive responses

greater percentage of males has shown strongly positive responses while greater

percentage of female participants has shown greater positive or moderately positive

responses. The percentage of neutral responses is more as compared to females; a similar

67

pattern can be seen in negative responses where male participants have more negative

responses than females. Difference in responses of females and males is insignificant. In

case of married or single participants, married participants show strongly positive and

moderately positive responses as compared to singles. On the other side strongly negative

or negative responses are once again from married participants. The difference in

responses of married and single participants is significant. Strong positive responses are

directly proportional to the marital status of the participants.

Comparing results of responses from participants having professional experience

differences, its is interesting to know that highest percentage of strongly and moderately

positive responses is similar in two categories,

Participants having professional experience of 1-5 years

Participants with professional experience of more than 16 years.

Moreover, the above two categories show highest percentage of strongly negative and

moderately negative responses. In case of neutral responses, participants with 11-15

professional experiences show least percentage of responses, which makes the results

highly significant. Thus marital status and professional experience turn out to be

significant indicator to advocate that doctors should have ability to communicate in

various languages.

Table 4.12:


(Doctors' choice of words affects communication skills)

Key Strongly

Agree


Disagree

Total

Frequency 128 94 16 2 3 243

Male 30.5% 23.5% 3.3% 0.8% 0.0% 58.0%

Female 22.2% 15.2% 3.3% 0.0% 1.2% 42.0%

Total 52.7% 38.7% 6.6% 0.8% 1.2% 100.0%

Chi-square = 6.283Asymp. Sig. (2-sided) = .179

68

Above table shows sex based variation in response to LF3. 54 percent of the male

participants agree with the statement against 37 of the female participants of the research.

1.2 percent of females and 0.8 percent males disagree with the statement provided in

LF3. Chi value shows that the difference in responses of male and female participants is

insignificant.

Table 4.13:



Key Strongly

Agree


Disagree

Total

Frequency 128 94 16 2 3 243

Single 18.5% 10.7% 3.3% 0.8% 0.0% 33.3%

Married 34.2% 28.0% 3.3% 0.0% 1.2% 66.7%

Total 52.7% 38.7% 6.6% 0.8% 1.2% 100.0%


62 percent of the married participants agree with the statement in contrast to

29percent of singles. 3 percent of the singles are uncertain about the statement provided

in LF3. 1 % singles and 2% married participants disagree with the given statement. The

difference in the responses of married and single participants is significant.

69

Table 4.14:



Key Strongly

Agree


Disagree

Total

Frequency 128 94 16 2 3 243

1-5 years 23.0% 11.5% 2.5% 0.8% 1.2% 39.1%

6-10 years 8.6% 12.3% 0.8% 0.0% 0.0% 21.8%

11-15 yrs 10.7% 10.7% 2.5% 0.0% 0.0% 9.1%

More than

16 years

16.9% 10.7% 2.5% 0.0% 0.0% 30.0%

Total 52.7% 38.7% 6.6% 0.8% 1.2% 100%


35 percent of group 1 professionals, 21 percent of group 2, 22 percent of group 3

and 17 percent of group 4 professionals agree with the statement in LF3. Professional of

group 3 gives highest percentage of neutral responses whereas highest percentage of

negative responses (2%) is shown by the professionals of group 1.

Discussion (LF 3):

Majority of participants affirm that doctor‟s choice of words affects

communication skills. In positive responses to the given statement gender differences

remain unimportant however in positive responses greater percentage of males has shown

greatly positive response as compare to females. The percentage of neutral responses has

higher ratio from female participants compared with males. The difference in male and

female responses is insignificant. Marital status of the participants turn out to be an

indicator for knowing that doctors choice of words affects communication, table 4.13

shows the significant differences in responses of married and single participants. Highest

percentage of married participants has greatly positive and moderately positive responses

as compared to singles. Married people showed highly negative responses while singles

70

have shown moderately positive responses. The difference in neutral responses of

married or single participants is insignificant. Professional experience of participants has

emerged as a significant indicator to show that the use of words by doctors affects

communication. Highest percentage of positive and negative responses is observed from

participants who have 1-5 year of experience; highest percentage of neutral responses is

give by group 3. This shows that at the start of career doctors are well aware of the fact

that use of jargons in their conversation can affect the communication going on between

doctors and patients. Next two groups of professionally experienced people have less

positive responses. Positive and negative vary significantly when we see data in table.

Thus professional experience shows highly significant variation in opinion of participants

with varied professional experiences.

Table 4.15:


(Doctors should explain information about disease and medicine to their patients in

detail)

Key Strongly

Agree


Disagree

Total

Frequency 96 96 25 23 3 243

Male 21.0% 24.3% 7.0% 5.8% 0.0% 58.0%

Female 18.5% 15.2% 3.3% 3.7% 1.2% 42.0%

Total 39.5% 39.5% 10.3% 9.5% 1.2% 100.0%


45 percent of males and 34 percent of females agree with the statement LF4. The

male participants provided 7 % neutral responses and the percentage of neutral responses

given by the females is 3 %. 6 % males disagree with the statement; in females this

percentage is 5. Chi values are insignificant.

71

Table 4.16:


should explain information about disease and medicine to their patients in detail)

Key Strongly

Agree


Disagree

Total

Frequency 96 96 25 23 3 243

Single 10.7% 16.9% 4.5% 1.2% 0.0% 33.3%

Married 28.8% 22.6% 5.8% 8.2% 1.2% 66.7%

Total 39.5% 39.5% 10.3% 9.5% 1.2% 100.0%


27 % of the single participants agree with the statement provided in LF 4 and 51

% of the married participants also agree. Highest percentages of neutral responses come

from the single participants of the research group, which is 6%. Only 5 % of married

participants showed neutral responses.

Table 4.17:

Professional experience-based variation in the responses to Questionnaire item 4

(Doctors should explain information about disease and medicine to their patients in

detail)

Key Strongly

Agree


Disagree

Total

Frequency 96 96 25 2 23 243

1-5 years 12.8% 18.9% 4.9% 1.2% 1.2% 39.1%

6-10 years 11.5% 2.9% 3.3% 4.1% 0.0% 21.8%

11-15 yrs 5.8% 0.8% 0.0% 2.5% 0.0% 9.1%

More than

16 years

9.5% 16.9% 2.1% 1.6% 0.0% 30.0%

Total 39.5% 39.5% 10.3% 0.8% 9.5% 100%


72

31% participants of group 1 professionals, 15 % group 2 participants, 14 % group

3 participants, and 6 percent group 4 professionals agree with the statement LF 4. 3% of

group 3 professionals disagree with the statement and 4% group 2 professionals remained

neutral to the statement. The results of this table are highly significant and the chi value is

56.425.

Discussion (LF 4):

Responses of male and female participants to LF 4 show an agreement to the

statement that doctors should explain information about disease and medicine to their

patients in detail. Keeping in view sex-based variation of responses, highest percentage of

positive responses comes from the female participants as compared to positive responses

from males. Similarly, in negative responses, percentage of female responses is higher

than males however in neutral responses percentage of male participants is higher than

females. In positive or negative responses to LF 4 (as shown in table 4.15), gender

difference remains unimportant and the difference in responses is insignificant.

Comparing results obtained from married and single participants show that majority of

single participants agree with the statement of issue. On the contrary, highest percentage

of negative responses comes from married participants. It is interesting to know that

highly negative responses come from married people while single participants have

moderately negative responses. Overall difference of responses in responses of married

and single participants is significant and can be used as pointer to find out that doctors

should explain information to the patients. Professional experience turns out to be another

important indicator to know about need of sharing information between doctor and

patient. Highest percentage of positive responses comes from participants having

experience of 16 years or more. Surprisingly people with 1-5 years have second highest

percentage of positive responses and it appears that at start of career professionals are

aware of the need of sharing information about medicine and disease to patients but with

passage of time need to share information is forgotten or compromised due to some other

factors. Highest positive responses from participants professionals with more than 16

years of experience shows that sharing information with patient is crucial and experience

helps professionals to admit the fact. Highest negative responses have come from people

73

with 11-15 years of professional experience. Group of participants with 11-15 years of

experience shows highest percentage of neutral responses. Professional experience

appears to be a good indicator to see the difference of opinions, as the results are highly

significant.

Table 4.18:


(Language barriers are faced by doctors in communicating with patients)

Key Strongly

Agree


Disagree

Total

Frequency 96 98 44 5 0 243

Male 24.3% 20.6% 12.3% 0.8% 0% 58.0%

Female 15.2% 19.8% 5.8% 1.2% 0% 42.0%

Total 39.5% 40.3% 18.1% 2.1% 0% 100.0%


35 percent females and 45 percent males agree with the statement LF 4. 12%

males and 6% females are uncertain about the statement. The chi-square value 4.969

shows that the results are significant.

Table 4.19:



Key Strongly

Agree


Disagree

Total

Frequency 96 98 44 5 0 243

Single 9.5% 17.3% 5.8% 0.8% 0% 33.3%

Married 30.0% 23.0% 12.3% 1.2% 0% 66.7%

Total 39.5% 40.3% 18.1% 2.1% 0% 100.0%


74

53 percent married participants show an agreement to the statement provided in

LF 5 and 27 percent singles also agree to the statement. 2% married and 1% singles

disagree with the statement. 12 % married and 6 % singles remained neutral in response

to this question. Chi-square value of this response is 7.492, which is insignificant.

Table 4.20:



Key Strongly

Agree


Disagree

Total

Frequency 96 98 44 5 0 243

1-5 years 13.6% 19.8% 3.7% 2.1% 0% 39.1%

6-10 years 7.4% 7.4% 7.0% 0.0% 0% 21.8%

11-15 yrs 5.8% 1.6% 1.6% 0.0% 0% 9.1%

More than

16 years

12.8% 11.5% 5.8% 0.0% 0% 30.0%

Total 39.5% 40.3% 18.1% 2.1% 0% 100%


Above table shows responses of professionals with different experiences. 33

percent of group 1 members with highest percentage agree with the statement. 7 %

participants of group 2 are uncertain about the statement whereas 4percent of group 1

participants show a disagreement to the statement. Chi value 27.550 shows that the

results are highly significant.

Discussion (LF 5):

Results demonstrate that majority of participants agree that language barriers are

faced by doctors while communicating with the patients. The percentage of neutral

responses from females is higher as compared to percentage of male‟s responses. In

positive responses to the given statement gender difference remains unimportant however

in positive responses greater percentage of females has shown strongly positive and

75

moderately positive responses. Similarly in negative responses, greater percentage is of

female participants. Gender difference in response to LF 5 appears to be insignificant.

Like gender difference, marital status has shown insignificant results. Marital status of

the participants does not create much difference in positive, negative or neutral responses.

The professionals with 1-5 years of experience show highest percentage of positive

responses to LF 5 and the same group of participants has highest percentage of negative

responses. Participants belonging to group two with 6-10 years have recorded highest

percentage of neutral responses. Participants with varied professional experience have

responded differently and the difference in responses turns out to be highly significant.

Professional experience of participants emerges an eminent indicator to study about the

language barriers faced by doctors while communicating with the patients.

Table 4.21:


(Language barriers occur when people do not speak the same language)

Key Strongly

Agree


Disagree

Total

Frequency 105 88 25 11 14 243

Male 25.9% 20.6% 6.2% 1.2% 4.1% 58.0%

Female 41.2% 37.3% 9.8% 7.8% 3.9% 42.0%

Total 67.1% 57.9% 16.0% 9.0% 8.0% 100.0%


The above table shows that 46% males and 78% females agree with the statement.

Percentage of uncertainty in case of males and females is 6 and 10 respectively. 10

percent males are not certain about the statement. Chi value is 5.565 showing that the

results are significant.

76

Table 4.22:

Marital status-based variation in the responses to Questionnaire item 6 (Language

barriers occur when people do not speak the same language)

Key Strongly

Agree


Disagree

Total

Frequency 105 88 25 11 14 243

Single 17.3% 11.1% 1.6% 2.5% 0.8% 33.3%

Married 25.9% 25.1% 8.6% 2.1% 4.9% 66.7%

Total 43.2% 36.2% 10.3% 4.5% 5.8% 100.0%


In response to LF 6 51% married and 28 % singles agree with the statement. 9

percent married and 2 % singles remained neutral in response to the statement. Chi value

of 10.271 proves that results are significant and cannot be ignored.

Table 4.23:


(Language barriers occur when people do not speak the same language)

Key Strongly

Agree


Disagree

Total

Frequency 105 88 25 11 14 243

1-5 years 16.0% 15.2% 0.8% 3.7% 3.3% 39.1%

6-10 years 9.5% 6.6% 5.8% 0.0% 0.0% 21.8%

11-15 yrs 4.1% 2.5% 0.0% 0.0% 2.5% 9.1%

More than

16 years

13.6% 11.9% 3.7% 0.8% 0.0% 30.0%

Total 43.2% 36.2% 10.3% 4.5% 5.8% 100%


77

25 percent of group 4 professionals are in agreement with the statement in LF6. 7

percent participants belonging to group 1 disagree with the statement. 6 percent

participants of the group 2 did not agree or disagree with the statement. Chi value of

58.939 shows that result is highly significant.

Discussion (LF 6):

Table 4.21 shows responses of participants to statement that language barriers

occur when people do not speak the same language. Highest percentage of neutral

responses comes from the male participants of the research. In positive responses greater

percentage of male participants has shown strongly positive and moderately positive

response compared with females, but the difference in percentages of females and males

responses is negligible and remains unimportant. So difference in gender-based responses

is insignificant and can be ignored. Comparing responses of married and single

participants, single participants have shown higher percentage of positive responses

compared to males while greater percentage of married participants has shown greater

percentage of negative responses. The percentage of neutral responses is significant

which have higher ration of married compare with single participants. Difference in

negative responses of married and single participants appears to be a significant indicator

to show that language barriers occur when people speak different languages. Professional

experience of participants has highly significant results and variation in responses is

shown in table 4.23. In case of positive responses, highest percentage of positive

responses comes from participants having professional experience of more than 16 years

while highest percentage of negative responses to the statement come form participants at

the start of career with professional experiences of 1-5 years. Participants of PE group 2

show highest number of neutral responses. Keeping in view highly significant difference

in the opinion of participants with least and most experience prove that professionals get

aware of communication barrier problem after practicing for long time.

78

Table 4.24:


(Language barriers reduce patient’s abilities to follow instructions and adhere to

treatments)

Key Strongly

Agree


Disagree

Total

Frequency 115 86 16 14 12 243

Male 29.2% 18.5% 2.9% 3.3% 4.1% 58.0%

Female 18.1% 16.9% 3.7% 2.5% 0.8% 42.0%

Total 47.3% 35.4% 6.6% 5.8% 4.9% 100.0%


Table 4.24 shows that 35 percent female participants agreed with statement LF 7.

The male participants agreement percentage is 47 % males and 4% females were

uncertain about the statement. Chi value of 6.297 proves results to be insignificant.

Table 4.25:

Marital status -based variation in the responses to Questionnaire item 7 (Language

barriers reduce patient’s abilities to follow instructions and adhere to treatments)

Key Strongly

Agree


Disagree

Total

Frequency 115 86 16 14 12 243

Single 15.2% 15.2% 2.1% 0.0% 0.8% 33.3%

Married 32.1% 20.2% 4.5% 5.8% 4.1% 66.7%

Total 47.3% 35.4% 6.6% 5.8% 4.9% 100.0%


Above given table shows that 30% singles and 52% married participants agree

with LF 7 statement. 10% married and 1% single do not agree with the statement.

Highest percentage of neutral responses comes from married participants. Chi-square

shows the difference to be significant.

79

Table 4.26:


(Language barriers reduce patient’s abilities to follow instructions and adhere to

treatments)

Key Strongly

Agree


Disagree

Total

Frequency 115 86 16 14 12 243

1-5 years 20.2% 14.8% 2.1% 1.2% 0.8% 39.1%

6-10 years 4.5% 8.6% 2.5% 2.1% 4.1% 21.8%

11-15 yrs 5.8% 3.3% 0.0% 0.0% 0.0% 9.1%

More than

16 years

16.9% 8.6% 2.1% 2.5% 0.0% 30.0%

Total 47.3% 35.4% 6.6% 5.8% 4.9% 100%


Table 4.26 shows LF 7 responses of participant having varied professional

experience. 35 % group 1, 13% group 2, 9% group 3 and 25 % of group 4 professionals

agrees with the statement. Group 2 participants have provided highest percentage of

neutral responses and the same group has provided maximum percentage of negative

responses i.e. 7%. Chi value 47.025 shows that the results are highly significant. The

difference is highly significant as shown by the value of chi-square.

Discussion (LF 7):

A great majority of participants agree with the statement that language barriers

reduce patients‟ ability to follow instructions and adhere to the treatment. In sex-based

variation, the males as compared to females show higher percentage of positive responses

but the difference in positive responses of both genders is minor, insignificant and can be

ignored. Greater percentage of highly negative or moderately negative response comes

from the male participants while the female participants of the research give more neutral

responses. Gender difference cannot be a good indicator to see the impact of language

80

barrier on the patient‟s ability to adhere with the treatment. In marital status- based data

collection, highest positive responses come from single participants while highest

percentage of negative responses comes from married participants. Married participants

have shown the highest percentage of neutral responses. The difference in negative

responses of singles and married participants turn out to be significant. Highly significant

difference can be seen in responses of participants have different duration of professional

experiences. Group 3 having experience of 11-15 years show maximum percentage of

positive responses. The participants having experience of 6-10 years show highest

percentage of negative responses. The same category of professionals shows highest

percentage of neutral responses. The difference in responses of participants belonging to

different groups of professional experience provides a highly significant variation of

responses.

Table 4.27:


(Language differences can create an obstacle to effective interaction between

doctors and patients)

Key Strongly

Agree


Disagree

Total

Frequency 84 109 24 21 5 243

Male 20.6% 26.7% 5.8% 4.1% 0.8% 58.0%

Female 14.0% 18.1% 4.1% 4.5% 1.2% 42.0%

Total 34.6% 44.9% 9.9% 8.6% 2.1% 100.0%


Above table have results of sex-base variation of responses to LF 8. 47 percent

male and 32 percent professionals agree to the statement whereas 5 females and 6%

males do not agree with the statement. Chi value 1.795 shows that the results are

insignificant.

81

Table 4.28:




Key Strongly

Agree


Disagree

Total

Frequency 84 109 24 21 5 243

Single 13.6% 14.8% 4.1% 0.0% 0.8% 33.3%

Married 21.0% 30.0% 5.8% 8.6% 1.2% 66.7%

Total 34.6% 44.9% 9.9% 8.6% 2.1% 100.0%


28 % single participants and 51% married participants validate the correctness of

the statement provided in LF 8 by agreeing with it. Chi square value 12.694 shows that

variation in responses is significant.

Table 4.29:




Key Strongly

Agree


Disagree

Total

Frequency 84 109 24 21 5 243

1-5 years 16.5% 14.0% 4.1% 2.5% 2.1% 39.1%

6-10 years 4.1% 11.5% 3.7% 2.5% 0.0% 21.8%

11-15 yrs 4.9% 1.6% 0.0% 2.5% 0.0% 9.1%

More than

16 years

9.1% 17.7% 2.1% 1.2% 0.0% 30.0%

Total 34.6% 44.9% 9.9% 8.6% 2.1% 100%


82

3% of the group 3 participants disagree with the statement LF8. Group 4

participants have highest level of agreement and 27% group 4 participants agree with the

LF8. 4% of group 2 participants remained neutral in response to this statement. Chi value

42.484 shows that the results are highly significant.

Discussion (LF 8):

Results demonstrate that language differences can create an obstacle to effective

interaction between doctors and patients. Males show highest percentage of positive

responses compare with females. The difference in highly positive and moderately

positive responses of both genders is insignificant and can be ignored. Greater percentage

of negative responses comes from females while males have less percentage of negative

responses. Both genders show similar percentages in neutral responses to the statement.

Difference in neutral, positive and negative responses of both genders does not show

significant difference in responses. On comparing results of marital based variation,

difference in responses of married and single participants is significant. Significantly

varied negative and neutral responses can be seen in table 4.28. The single participants

show highest percentage of positive responses while highest percentage of negative

responses comes from the married participants. Single participants provided greater

percentage of neutral responses. In case of professionally experienced groups, group 4

has shown highest percentage of positive responses. Professionals of group 3 have shown

highest percentage of negative responses while group two appears to be most neutral in

response to the statement. Participants having different professional experience of

different years provide highly significant difference in the responses.

83

Table 4.30:


(Using visuals (photographs, drawings, diagrams) can help to overcome language

barriers)

Key Strongly

Agree


Disagree

Total

Frequency 49 111 54 20 9 243

Male 11.1% 25.5% 14.8% 5.3% 1.2% 58.0%

Female 9.1% 20.2% 7.4% 2.9% 2.5% 42.0%

Total 20.2% 45.7% 22.2% 8.2% 3.7% 100.0%


Table 4.30 shows data variation in responses of males and females. 29 female

participants agree with the statement and the percentage of males who agree is 37 only.

5% females and 6% males disagree with the statement. 15 % males do not agree or

disagree to the statement. Chi-square values show that the variation is insignificant.

Table 4.31:



barriers)

Key Strongly

Agree


Disagree

Total

Frequency 49 111 54 20 9 243

Single 7.4% 14.4% 10.7% 0.8% 0.0% 33.3%

Married 12.8% 31.3% 11.5% 7.4% 3.7% 66.7%

Total 20.2% 45.7% 22.2% 8.2% 3.7% 100.0%


Table 4.31 shows responses of married and unmarried professionals. 44% married

and 22% single participants agree to LF 9. On the contrary 11% married and 1% single

84

do not agree with the statement. The chi-square value of 15.151 tells that the variation is

significant and cannot be ignored.

Table 4.32:



barriers)

Key Strongly

Agree


Disagree

Total

Frequency 49 111 54 20 9 243

1-5 years 9.9% 16.0% 9.9% 2.1% 1.2% 39.1%

6-10 years 3.7% 6.2% 7.8% 4.1% 0.0% 21.8%

11-15 yrs 2.5% 2.5% 1.6% 0.0% 2.5% 9.1%

More than

16 years

4.1% 21.0% 2.9% 2.1% 0.0% 30.0%

Total 20.2% 45.7% 22.2% 8.2% 3.7% 100%


As shown in above table, group 4 professionals show highest percentage of

positive responses. 25% of group 4 professionals agree with the statement. And highest

percentage of disagreement can be seen in third group having 3 % disagreement. 8

percent participants of group 2 remained neutral. Chi square value for this table is 76.734

showing results to be highly significant.

Discussion (LF 9):

In positive responses to statement that using visuals (photographs, drawings, and

diagrams) can help to overcome the language barriers, highly positive responses are

collected from the female participants compared with males. There is insignificant

difference in positive responses gathered from male and female participants however the

female participants show highest percentage of negative responses. Majority of male

85

remained neutral in response to the statement. In positive responses, both married and

single participants show equal percentage of agreement with the statement. Married

participants have shown higher percentage of negative responses than singles. A

significant difference can be seen in the neutral response to the statement where singles

have higher percentage of neutral response compared to married participants. Differences

of experience turn out to be most prominent indicator in variation of responses to LF 9.

Participant with more than 16 years of professional experience (group 4) show highest

percentage of positive responses while highest percentage of negative responses comes

from group 3. Professionals of group 3 showed maximum number of neutral responses.

Overall, professional experience of participants provides highly significant results and

professional experience works as a good indicator to find about the use of visual aids to

overcome the language barriers.

Table 4.33:


(Non verbal expressions also contribute to effective communication)

Key Strongly

Agree


Disagree

Total

Frequency 59 78 80 11 15 243

Male 16.5% 14.4% 21.8% 2.1% 3.3% 58.0%

Female 7.8% 17.7% 11.1% 2.5% 2.9% 42.0%

Total 24.3% 32.1% 32.9% 4.5% 6.2% 100.0%


26 % females and 31 percent males agree with LF 10 statement. On the other

hand 5% females and 6% males disagree with the statement. 22 percent male participants

showed neutral response for the given statement. Chi-square shows the difference to be

insignificant.

86

Table 4.34:



Key Strongly

Agree


Disagree

Total

Frequency 59 78 80 11 15 243

Single 5.8% 11.9% 14.4% 0.0% 1.2% 33.3%

Married 18.5% 20.2% 18.5% 4.5% 4.9% 66.7%

Total 24.3% 32.1% 32.9% 4.5% 6.2% 100.0%


Table 4.34 provides evidence that 39 % married and 25 % single agree with the

statement LF 10. 10% married and 1% singles disagree with the statement. 14% singles

and 15% married remained neutral in response to the given statement. Chi-square value is

significant for this statement.

Table 4.35:



Key Strongly

Agree


Disagree

Total

Frequency 59 78 80 11 15 243

1-5 years 7.4% 16.9% 14.8% 0.0% 0.0% 39.1%

6-10 years 6.2% 2.5% 9.5% 1.6% 2.1% 21.8%

11-15 yrs 4.1% 0.8% 2.5% 1.6% 0.0% 9.1%

More than

16 years

6.6% 11.9% 6.2% 0.0% 0.0% 30.0%

Total 24.3% 32.1% 32.9% 4.5% 6.2% 100%


87

15 percent participants belonging to group 1 remained neutral in response to the

statement. 24 % professionals of group 1 agree and 5% participants of group 3 disagree

with the statement LF 10. Chi-square value 56.776 shows that variation on base of

marital-status is highly significant.

Discussion (LF 10):

In response to the statement, “Non-verbal expressions also contribute to effective

communication”, highest positive responses come from female participants compared

with male participants. However the male participants show highest percentage of

negative responses. In given statement gender difference remains unimportant. In positive

response greater percentage of married participants has shown strongly positive response

similarly greater percentage of marrieds have shown greater negative and moderately

negative responses. A significant difference in neutral responses of married and single

participants can be observed in table 4.34. Professional experience difference emerged as

stronger indicator to find variation in responses. People belonging to group 4 have shown

highest percentage of responses however greater percentage of negative responses is

shown by professionals from group 3. A highly significant difference in negative and

neutral responses of different groups is visible in table 4.35. Highest percentage of

neutral response appears in group-2 of professionals.

II. Doctors’ Training (DT11-DT17)

Table 4.36:


(Doctors’ training in communication skills should be mandatory for medical

profession)

Key Strongly

Agree


Disagree

Total

Frequency 80 109 27 10 17 243

Male 18.9% 28.0% 4.5% 2.5% 4.1% 58.0%

Female 14.0% 16.9% 6.6% 1.6% 2.9% 42.0%

Total 32.9% 44.9% 11.1% 4.1% 7.0% 100.0%


88

Above table shows variation on the basis of sex. Results show that 47%male and

21% females agree with the statement. The disagreement percentage is equal in case of

both genders, 7% males and females disagree. 5% males and 8% females remained

neutral in response to the statement. Chi-square value of 4.192 proves results to be

insignificant.

Table 4.37:



profession)

Key Strongly

Agree


Disagree

Total

Frequency 80 109 27 10 17 243

Single 11.5% 16.0% 2.5% 2.5% 0.8% 33.3%

Married 21.4% 28.8% 8.6% 1.6% 6.2% 66.7%

Total 32.9% 44.9% 11.1% 4.1% 7.0% 100.0%


Table 4.37 has data of married and married people. 28% singles and 50 % married

people agree with the statement while 8% married and 3 percent singles did not agree

with the statement. 9% married and 3% singles were uncertain about the statement. Chi

value for this response is 8.652 and the variation for DT 11 is significant.

89

Table 4.38:

Professional experience -based variation in the responses to

Questionnaire item 11


profession)

Key Strongly

Agree


Disagree

Total

Frequency 80 109 27 10 17 243

1-5 years 8.2% 21.0% 2.9% 2.5% 4.5% 39.1%

6-10 years 11.5% 7.4% 2.9% 0.0% 0.0% 21.8%

11-15 yrs 3.3% 1.6% 0.0% 1.6% 2.5% 9.1%

More than

16 years

9.9% 14.8% 5.3% 0.0% 0.0% 30.0%

Total 28.0% 46.1% 15.6% 4.1% 6.2% 100%


Above given table (4.38) shows responses of different professional groups. Group

4 and 3 show highest percentages of agreement and disagreement respectively. 5 % of

those who are uncertain belong to group 4. The variation of responses is highly

significant with chi value 65.667.

Discussion (DT 11):

In response to statement that doctors‟ training in communication skills should be

mandatory for medical profession, the male participants of the research show highest

percentage of positive response. Females and males have provided equal percentage of

moderately and highly negative responses so the level of disagreement to the statement is

same as their responses show. The difference in positive responses of both genders is

insignificant. Majority of females remained neutral in response to the statement and are

not sure if doctors‟ training in communication skills is necessary or not. Comparing the

results from married and single participants, greater percentage of strong and moderate

responses is shown by the single participants compared with married participants.

90

Married participants have shown more disagreement to the statement and the difference

in negative responses of single and married participants appears to be significant. Most of

married participants remained neutral to the statement compared with singles. The

difference in responses of married and unmarried people is significant and cannot be

ignored. Data gathered from professionals provides highly significant difference and

most varied responses. Group 4 having most experienced people in the group shows

highest percentage of positive responses (Table 4.38). The highest percentage of positive

responses from most experience people justifies the statement that there is need for

mandatory training for doctors to improve communication skills. On comparing neutral

responses of all group highest percentage of neutral responses are shown by group 4.

Group 3 professionals with experience of 11-15 years have provided highest percentage

of negative responses. Comparing the neutral and negative percentages of different

groups makes the variation of responses highly significant where group 2 and 4 of

professionals shows nil negative response.

Table 4.39:

Sex -based variation in the responses to Questionnaire item 12

(Doctors' training in communication affects doctor-patient communication)

Key Strongly

Agree


Disagree

Total

Frequency 92 114 20 2 15 243

Male 21.0% 26.3% 6.6% 0.0% 4.1% 58.0%

Female 16.9% 20.6% 1.6% 0.8% 2.1% 42.0%

Total 37.9% 46.9% 8.2% 0.8% 6.2% 100.0%


DT 12 responses given by males and females are provided in table 4.39. 37

percent females and 47% males agree with the statement whereas 7% males and females

disagree with the statement. 7% males remained neutral in response to DT 12. The

variation in the responses of both genders is insignificant.

91

Table 4.40:

Marital status-based variation in the responses to Questionnaire item 12


Key Strongly

Agree


Disagree

Total

Frequency 92 114 20 2 15 243

Single 14.4% 16.0% 2.1% 0.0% 0.8% 33.3%

Married 23.5% 30.9% 6.2% 0.8% 5.3% 66.7%

Total 37.9% 46.9% 8.2% 0.8% 6.2% 100.0%


30% single participants and 54 percent married participants agree with the

statement DT 12. On the contrary 6% married and 1% singles disagree with the

statement. Chi values are significant in this case.

Table 4.41:



Key Strongly

Agree


Disagree

Total

Frequency 92 114 20 2 15 243

1-5 years 13.6% 21.4% 2.1% 0.0% 2.1% 39.1%

6-10 years 7.8% 7.8% 1.2% 0.8% 4.1% 21.8%

11-15 yrs 4.9% 4.1% 0.0% 0.0% 0.0% 9.1%

More than

16 years

9.9% 14.8% 5.3% 0.0% 0.0% 30.0%

Total 37.9% 46.9% 8.2% 0.8% 6.2% 100%


92

As shown in table 4.41, highest level of agreement is shown by the professionals

belonging to group 1 having 1-5 years of experience. 9 % professionals of group 3 agree

with DT 12. 5 percent professionals belonging to group 2 disagree with the statement and

5% of group 4 participants remained neutral in response to the question. With chi value

of 40.802, it is evident that the results are highly significant.

Discussion (DT 12):

Results demonstrate that majority of female participants believe that doctor‟s

training in communication affects doctor-patient medical discourse. The percentage of

highly positive and moderately positive responses from two genders show insignificant

difference and can be ignored. Greater percentages of male‟s remained neutral on the

statement about affect of doctors training; most negative responses also come from the

male participants of the research. Seeing the results obtained from married and single

participants, significant difference in opinion of two groups is shown in table 4.40.

Highest the married participants show percentages of negative and neutral responses

compared with singles however highest percentage of highly or moderately positive

responses comes from the single participants. The responses of married and singles show

significant difference in opinion; marital status of the participants can be used as

indicator to study the variation of responses. Highly significant variation of responses is

gathered from people with diverse professional experience. 100 % positive responses

from group three of professionals show the severity of problem and affirming that the

doctors‟ training in communication affects the doctor-patient medical discourse. It is

strange that highest percentage of neutral responses are given by the most experienced

professionals of group 4, either they are already so good at communicating with patients

due to experience or they do not realize the severity of situation. Highest percentage of

negative responses is recorded from the professionals with 6-10 years of experience. Nil

negative responses from group 3 and 4 make the results highly significant. Professional

experience based responses show significant variation in opinion of participants and

cannot be ignored.

93

Table 4.42:


(Successful medical encounters require effective communication skills between the

patient and the doctor)

Key Strongly

Agree


Disagree

Total

Frequency 78 130 21 9 5 243

Male 18.5% 31.3% 5.3% 2.1% 0.8% 58.0%

Female 13.6% 22.2% 3.3% 1.6% 1.2% 42.0%

Total 32.1% 53.5% 8.6% 3.7% 2.0% 100.0%

Chi-square = 0.833 Asymp. Sig. (2-sided) = 0.934

Table 4.42 shows variation in responses shown by males and females. 50% if

males and 36 % female participants agree with the statement. 3% males and 4% males

disagree with the statement DT 13. Chi-square value 0.833 shows that the variation is

insignificant.

Table 4.43:




Key Strongly

Agree


Disagree

Total

Frequency 78 130 21 9 5 243

Single 11.9% 17.7% 1.6% 1.2% 0.8% 33.3%

Married 20.2% 35.8% 7.0% 2.5% 1.2% 66.7%

Total 32.1% 53.5% 8.6% 3.7% 2.0% 100.0%


94

55 percent married and 29 percent single participants agree with statement DT 13.

4% married and singles did not agree with the statement. Chi-square has value of 2.552

showing the difference to be insignificant.

Table 4.44:




Key Strongly

Agree


Disagree

Total

Frequency 78 130 21 9 5 243

1-5 years 15.2% 16.5% 4.1% 1.2% 2.1% 39.1%

6-10 years 6.2% 14.8% 0.8% 0.0% 0.0% 21.8%

11-15 yrs 3.3% 3.3% 0.0% 2.5% 0.0% 9.1%

More than

16 years

7.4% 18.9% 3.7% 0.0% 0.0% 30.0%

Total 32.1% 53.5% 8.6% 3.7% 2.1% 100%


Professionals having 6-10 years of experience showed 21 % of agreement. 3% of

group 3 professionals did not agree with the statement DT 13. 4% participants of group 4

were uncertain about the statement. The chi-square value 6.240 shows that the results are

significant.

Discussion (DT 13):

Majority of female participants show an agreement to the statement that

successful medical encounters require effective communication skills between the patient

and the doctor however majority of males remained neutral to the statement as they are

not sure whether successful medical meetings of doctor and patient require effective

communication skills or not. The female participants of the project provide highest

95

percentage of negative responses. The difference in responses of both genders is

insignificant and can be ignored. Single participants agree with the statement in majority.

The percentage of neutral responses is significant which have higher ratio of married

participants compared with singles. In positive response to the given statement gender

difference remains unimportant however in negative response greater percentage of

singles has shown moderately negative response similarly greater percentage of single

participants has shown greater positive and moderately positive responses. The

professional experience has emerged as a highly significant indicator to about the

requirement of effective communication skills of doctors. The percentage of neutral

responses is highly significant in case of group 4 professionals. In positive response

greater percentage of group 3 professionals has shown strongly positive response while

greater percentage of group 2 professionals has shown greater moderately positive

responses. The group 3 professionals show highest percentage of negative responses. The

differences in neutral and negative responses of different group appear to be highly

significant.

Table 4.45:


(Non opening of the discussion is due to lack of communication training)

Key Strongly

Agree


Disagree

Total

Frequency 49 91 65 27 11 49

Male 10.3% 19.3% 17.3% 8.6% 2.5% 58.0%

Female 9.9% 18.1% 9.5% 2.5% 2.1% 42.0%

Total 20.2% 37.4% 26.7% 11.1% 4.6% 100.0%


30% male and 28% female participants either strongly or moderately agrees with

the statement provided in DT 14. On the contrary, 11% males and 5% females disagree

with the statement. The variation in responses of males and female responses is

insignificant as chi value is only 8.045.

96

Table 4.46:



Key Strongly

Agree


Disagree

Total

Frequency 49 91 65 27 11 243

Single 4.9% 13.2% 9.9% 2.1% 3.3% 33.3%

Married 15.2% 24.3% 16.9% 9.1% 1.2% 66.7%

Total 20.2% 37.4% 26.7% 11.1% 4.5% 100.0%


Table 4.46 shows variation in response of professionals on basis of their marital

status. 40 % married and 18 % single participants agree with the statement given in DT

14. Significant variation in response of married and singles is apparent in Chi-square

value.

Table 4.47:



Key Strongly

Agree


Disagree

Total

Frequency 49 91 65 27 11 243

1-5 years 4.9% 18.1% 7.0% 4.5% 4.5% 39.1%

6-10 years 3.3% 4.5% 9.1% 4.9% 0.0% 21.8%

11-15 yrs 2.5% 4.9% 1.6% 0.0% 0.0% 9.1%

More than

16 years

9.5% 9.9% 9.1% 1.6% 0.0% 30.0%

Total 20.2% 37.4% 26.7% 11.1% 4.5% 100%


97

Professionals of group 1 with an experience of 1-5 years have highest percentage

of positive responses that is 23 %. On the contrary 9 % professionals belonging to group

1 disagree with the statement. Chi-square results show that variation is highly significant.

Discussion (DT 14):

It can be seen that majority of the participants agree to the statement that non-

opening of the discussion is due to lack of communication training. In positive response

to the given statement gender difference remains unimportant however in positive

response greater percentage of females has shown strongly positive response while

greater percentage of males has shown greater negative and moderately negative

responses. The male participants have showed highest percentage of neutral responses.

The difference is responses of both genders is insignificant and can be ignored. A

significant variation of responses can be seen in data gathered from married and single

participants. Highest percentage of positive responses is gathered from married

participants however the percentage of negative responses is same in both groups

(married & singles). In neutral responses marital status of the participants remain

unimportant however in negative and positive responses two groups show significant

difference. The professional experience of participants show a relationship with

understanding that non-opening of the discussion is due to lack of communication

training. Participants of group 3 show highest percentage of agreement to the statement

however greater negative responses are shown by participants of group 1. Professional

experience of the participants emerged as a highly significant indicator to test the

statement DT 14 and table 4.46 shows variation in responses of different groups of

professionals.

98

Table 4.48:


(Gathering and sharing information ability is due to communication training)

Key Strongly

Agree


Disagree

Total

Frequency 53 111 65 5 9 243

Male 10.3% 27.2% 17.7% 0.8% 2.1% 58.0%

Female 11.5% 18.5% 9.1% 1.2% 1.6% 42.0%

Total 21.8% 45.7% 26.7% 2.1% 3.7% 100.0%


In response to DT 15, 38% male participants and 30 % female participants have

shown an agreement. 3% males and 2% females disagree with the statement. The

variation differences are insignificant have chi-square value of only 5.111.

Table 4.49:



Key Strongly

Agree


Disagree

Total

Frequency 53 111 65 5 9 243

Single 3.7% 21.4% 7.0% 1.2% 0.0% 33.3%

Married 18.1% 24.3% 19.8% 0.8% 3.7% 66.7%

Total 21.8% 45.7% 26.7% 2.1% 3.7% 100.0%


The agreement percentages of married and single participants are 42 % and 25%

respectively. 1 % single and 4% married participants disagree to the statement provided

in DT 15. 20 % married participants were uncertain about the issue. The variation in

responses of married and singles is significant having value of 23.101.

99

Table 4.50:



Key Strongly

Agree


Disagree

Total

Frequency 53 111 65 53 5 243

1-5 years 6.2% 18.5% 9.5% 4.5% 1.2% 39.1%

6-10 years 2.9% 10.7% 7.4% 4.9% 0.8% 21.8%

11-15 yrs 4.9% 0.8% 3.3% 0.0% 0.0% 9.1%

More than

16 years

7.8% 15.6% 6.6% 1.6% 0.0% 30.0%

Total 21.8% 45.7% 26.7% 21.8% 2.1% 100%


Data shown in Table 4.50 shows the DT 15 responses shown by different groups

of professionals. With maximum percentage of 25 %, professional belonging to group 1

shows agreement to the statement. Highly significant difference in responses of different

groups can be seen in above table.

Discussion (DT 15):

Results demonstrate a strong agreement of participants to the statement that

gathering and sharing information ability is due to communication training. In sex-based

responses, greater majority of females provided positive responses compared with males.

Females give highest percentage of negative and moderately negative response while

greater percentage of males has shown neutral responses. The difference in responses of

males and female participants is insignificant. Comparing response of married and single

people, highest percentage of strong positive responses comes from married people while

singles have highest ratio of moderately positive response. A significant difference in

negative responses of married and single participants can be seen in table 4.48 where the

married participants of the research show highest percentage of negative response. The

100

percentage of neutral responses is significant and married people show a greater

percentage of neutral responses. Like previous discussion, professional experience of

participants emerged as a clear indicator of study. The percentage of neutral responses

given by groups show highly significant variation; however group 3 professionals have

shown highest percentage of neutral response. Group 3 participants have highest ration of

strong positive responses where as group 4 professionals have shown highest percentage

of moderately positive response. The percentage of negative responses is highly

significant and cannot be ignored.

Table 4.51:


(Understanding the patient's perspective is due to communication training)

Key Strongly

Agree


Disagree

Total

Frequency 53 111 65 5 9 243

Male 17.7% 25.9% 10.7% 2.1% 1.6% 58.0%

Female 11.9% 20.2% 7.0% 1.6% 1.2% 42.0%

Total 29.6% 46.1% 17.7% 3.7% 2.8% 100.0%

Chi-square = .360 Asymp. Sig. (2-sided) = .986

It can be seen that in total 44 % of the male participants agree with the given

statement against 32 % of the female. On the other side 4 % of the male disagree against

3 % of the female in total. Chi-square shows the difference to be significant.

101

Table 4.52:



Key Strongly

Agree


Disagree

Total

Frequency 72 112 43 9 7 243

Single 10.7% 15.6% 7.0% 0.0% 0.0% 33.3%

Married 18.9% 30.5% 10.7% 3.7% 2.9% 66.7%

Total 29.6% 46.1% 17.7% 3.7% 2.9% 100.0%


It can be seen that in total 49% of the married participants agree with the given

statement against 26 % of the single. On the other side 6 % of the married disagree with

the statement while the single who are 0% of the total. Chi-square shows the difference to

be significant.

Table 4.53:



Key Strongly

Agree


Disagree

Total

Frequency 53 111 65 9 7 243

1-5 years 13.2% 18.9% 5.8% 0.0% 1.2% 39.1%

6-10 years 8.6% 9.1% 4.1% 0.0% 0.0% 21.8%

11-15 yrs 3.3% 1.6% 0.0% 2.5% 1.6% 9.1%

More than

16 years

4.5% 16.5% 7.8% 1.2% 0.0% 30.0%

Total 21.8% 45.7% 26.7% 3.7% 2.9% 100%


102

32 % of those who agree have 1-6 years of professional experience and those who

disagree having 5 % belong to group 3 of professional experience. 8 % of those who are

uncertain belong to group 4. The difference is highly significant as shown by the value of

chi-square.

Discussion (DT 16):

Results demonstrate a strong agreement of the participants to statement that

understanding the patient's perspective is due to communication training. However, the

difference in neutral, positive and negative response of male and females is significant.

On average highest percentage of positive and negative response is shown by the female

participants as compared to males. The male participants gave most neutral responses.

Comparing responses of married and single participants, highest percentage of positive

response is shown by the singles while highest percentage of negative response comes

form the married participants of the research group. Significantly high ratio of singles

remained neutral in responses to the statement. Interestingly a greater percentage of

professionals with least professional experience show highest percentage of positive

response and agree that understanding the patient‟s perspective is due to communication

training, however participants of group 4 have shown highest percentage of neutral

response. In negative responses to the statement, highest percentage is of group 3

professionals. Once again variation in responses of professional groups turns out to be a

good indicator to test the statement and the results are highly significant.

Table 4.54:


(Provision of closure in interaction is due to communication training)

Key Strongly

Agree


Disagree

Total

Frequency 33 107 68 9 26 243

Male 8.2% 24.3% 14.4% 2.5% 8.6% 58.0%

Female 5.3% 19.8% 13.6% 1.2% 2.1% 42.0%

Total 13.6% 44.0% 28.0% 3.7% 10.7% 100.0%


103




Table 4.55:



Key Strongly

Agree


Disagree

Total

Frequency 33 107 68 9 26 243

Single 6.2% 19.8% 7.4% 0.0% 0.0% 33.3%

Married 7.4% 24.3% 20.6% 3.7% 10.7% 66.7%

Total 13.6% 44.0% 28.0% 3.7% 10.7% 100.0%


It can be seen that in total 32 % of the married participants agree with the given

statement against 26 % of the single. On the other side 14% of the married disagree with


be significant.

104

Table 4.56:



Key Strongly

Agree


Disagree

Total

Frequency 33 107 68 9 26 243

1-5 years 4.9% 22.6% 7.8% 1.2% 2.5% 39.1%

6-10 years 3.7% 8.6% 5.3% 0.0% 4.1% 21.8%

11-15 yrs 1.6% 0.8% 4.1% 2.5% 0.0% 9.1%

More than

16 years

3.3% 11.9% 10.7% 0.0% 4.1% 30.0%

Total 13.6% 44.0% 28.0% 3.7% 10.7% 100%



disagree having 4 % belong to group 2of professional experience. 11 % of those who are


chi-square.

Discussion (DT 17):

Overall, greater majority of participants agree to the statement that provision of

closure in interaction is due to communication training. In sex-based responses, greater

positive response comes from female participant while highest percentage of positive

responses comes from male participants. In neutral response to the statement, females

have higher percentage compared with males. In positive responses to statement, gender

difference remains unimportant but in neutral and negative responses significant

difference can be observed. The married participants give a greater percentage of highly

positive response and singles showed highest percentage of moderate positive response to

the statement while a higher percentage of strong positive response. A significant

difference in neutral response of singles and married participants is shown in table 4.55

105

however married participants of the research show highest percentage of neutral

response. Participants with 1-5 years of professional experience show highest percentage

of positive response while people of group 3 show highest percentage of negative

percentage. The greater percentage of neutral responses is shown by participants

belonging to group 3 of professionals. Difference in responses of different group is

highly significant.

III. Speaking Proficiency (SP18-SP22)

Table 4.57:


(The spoken language is the most important tool of communication in

m e d i c i n e )

Key Strongly

Agree


Disagree

Total

Frequency 84 127 17 9 6 243

Male 19.8% 32.1% 4.1% 0.8% 1.2% 58.0%

Female 14.8% 20.2% 2.9% 2.9% 1.2% 42.0%

Total 34.6% 52.3% 7.0% 3.7% 2.5% 100.0%


It can be seen that in total 52% of the male participants agree with the given

statement against 35% of the female. On the other side 2 % of the male disagree against 4

% of the female in total. Chi-square shows the difference to be insignificant.

106

Table 4.58:



m e d i c i n e )

Key Strongly

Agree


Disagree

Total

Frequency 84 127 17 9 6 243

Single 12.8% 16.9% 1.2% 2.5% 0.0% 33.3%

Married 21.8% 35.4% 5.8% 1.2% 2.5% 66.7%

Total 34.6% 52.3% 7.0% 3.7% 2.5% 100.0%





be significant.

Table 4.59:



m e d i c i n e )

Key Strongly

Agree


Disagree

Total

Frequency 33 107 68 9 26 243

1-5 years 4.9% 22.6% 7.8% 1.2% 2.5% 39.1%

6-10 years 3.7% 8.6% 5.3% 0.0% 4.1% 21.8%

11-15 yrs 1.6% 0.8% 4.1% 2.5% 0.0% 9.1%

More than

16 years

3.3% 11.9% 10.7% 0.0% 4.1% 30.0%

Total 13.6% 44.0% 28.0% 3.7% 10.7% 100%


107




chi-square.

Discussion (SP 18):

Majority of participants agree with the statement that the spoken language is the

most important tool of communication in medicine. The male candidates give highest

percentage of positive responses however difference in positive responses of two genders

is insignificant. The male participants have given a higher percentage of neutral response.

Female participants have shown percentage of negative responses. Overall the difference

in responses of two genders is insignificant and this data cannot be used to find answer of

the given statement. Table 4.58 shows the statistics gathered from married and single

participants of the research and the results demonstrate a strong agreement of the

participants to the statement. A higher percentage of strong positive responses come from

single participants; the married participants give higher percentage of moderate positive

response. Highest percentage of neutral responses is from participants who are married.

In negative response to the given statement greater percentage of response comes from

single participants of the research. The difference in negative, positive and neutral

responses of married and single participants is significant. Thus professional experience

shows relationship with positive responses to the statement. In positive responses greater

percentage of group 4 of professionals has shown greater positive response; group 1

participants have shown highest percentage of moderate positive responses. Highly

significant difference in neutral and negative responses can be seen in table 4.59 however

highest percentage of negative response are recorded by participants of group 3, same

group of professionals shows highest percentage of neutral response. Like previous

discussion results, professionals show highly significant difference of response and

professional experience emerges as good indicator to study variation of responses.

108

Table 4.60:


(The accent of speech used by the doctor also affects the patient's comprehension of

the doctor’s communication)

Key Strongly

Agree


Disagree

Total

Frequency 84 127 17 9 6 243

Male 19.8% 32.1% 4.1% 0.8% 1.2% 58.0%

Female 14.8% 20.2% 2.9% 2.9% 1.2% 42.0%

Total 34.6% 52.3% 7.0% 3.7% 2.5% 100.0%



statement against 35% of the female. On the other side 2 % of the male disagree against

4% of the female in total. Chi-square shows the difference to be insignificant.

Table 4.61:




Key Strongly

Agree


Disagree

Total

Frequency 52 113 41 31 6 243

Single 4.1% 17.7% 7.8% 1.2% 2.5% 33.3%

Married 17.3% 28.8% 9.1% 11.5% 0.0% 66.7%

Total 21.4% 46.5% 16.9% 12.8% 2.5% 100.0%



statement against 22% of the single. On the other side 12 % of the married disagree with

109

the statement while the single who are 11% of the total. Chi-square shows the difference

to be significant.4

Table 4.62:




Key Strongly

Agree


Disagree

Total

Frequency 52 113 41 31 6 243

1-5 years 7.4% 18.9% 6.6% 4.9% 1.2% 39.1%

6-10 years 3.7% 8.2% 3.3% 5.3% 1.2% 21.8%

11-15 yrs 1.6% 7.4% 0.0% 0.0% 0.0% 9.1%

More than

16 years

8.6% 11.9% 7.0% 2.5% 0.0% 30.0%

Total 21.4% 46.5% 16.9% 12.8% 2.5% 100%


26% of those who agree have 1-5 years of professional experience and those who

disagree having 7 % belong to group 2 of professionals. 7 % of those who are uncertain

belong to group 4. The difference is highly significant as shown by the value of chi-

square.

Discussion (SP 19):

Results demonstrate a strong agreement of the participants to statement that the

accent of speech used by the doctor also affects the patient's comprehension of the

doctor‟s communication. However, the difference in neutral, positive and negative

response of male and females is significant. On average highest percentage of positive

response is shown by the male participants as compared to females. The male participants

gave most neutral responses however the female participants show greater percentage of

110

negative response. Comparing responses of married and single participants, highest

percentage of positive response is shown by married participants while highest

percentage of neutral response comes form the single participants of the research group.

Significantly high percentage of married participants does not agree to the statement. The

difference in responses of males and females is significant. Interestingly a greater

percentage of professionals with 11-15 years of professional experience show highest

percentage of positive response and agree that accent of doctor matters affects patient‟s

comprehension, however participants of group 4 have shown highest percentage of

neutral response. In negative responses to the statement, highest percentage is of group 2

professionals. Once again variation in responses of professional groups turns out to be a


Table 4.63:


(Patients often have trouble in understanding doctors because he/she speaks too

fast)

Key Strongly

Agree


Disagree

Total

Frequency 41 91 66 42 3 243

Male 10.3% 18.9% 16.9% 11.9% 0.0% 58.0%

Female 6.6% 18.5% 10.3% 5.3% 1.2% 42.0%

Total 16.9% 37.4% 27.2% 17.3% 1.2% 100.0%




7 % of the female in total. Chi-square value shows the difference to be significant.

111

Table 4.64:



fast)

Key Strongly

Agree


Disagree

Total

Frequency 41 91 66 42 3 243

Single 7.0% 14.8% 7.4% 2.9% 1.2% 33.3%

Married 9.9% 22.6% 19.8% 14.4% 0.0% 66.7%

Total 16.9% 37.4% 27.2% 17.3% 1.2% 100.0%



statement against 22% of the single. On the other side 14 % of the married disagree with


be significant.

Table 4.65:



fast)

Key Strongly

Agree


Disagree

Total

Frequency 52 113 41 31 6 243

1-5 years 7.4% 18.9% 6.6% 4.9% 1.2% 39.1%

6-10 years 3.7% 8.2% 3.3% 5.3% 1.2% 21.8%

11-15 yrs 1.6% 7.4% 0.0% 0.0% 0.0% 9.1%

More than

16 years

8.6% 11.9% 7.0% 2.5% 0.0% 30.0%

Total 21.4% 46.5% 16.9% 12.8% 2.5% 100%


112

9 % of those who agree have 11-15 years of professional experience and those

who disagree having 7 % belong to group 2 of professional experience. 7 % of those who

are uncertain belong to group 1. The difference is highly significant as shown by the

value of chi-square.

Discussion (SP 20):

A highest percentage of participants agree that the patients often have trouble in

understanding doctors because he/she speaks too fast. Female participants show highest

percentage of positive responses compare with males. The difference in highly positive

and moderately positive responses of both genders is insignificant and can be ignored by

researcher; greater percentage of negative responses comes from males while females

have less percentage of negative responses. Males show higher percentages in neutral

responses to the statement. Difference in responses of both genders is significant. On

comparing results of marital status-based variation, difference in responses of married

and single participants is significant. Significantly varied negative and neutral responses

can be seen in table 4.64. The single participants show highest percentage of positive

responses while highest percentage of negative responses comes from the married

participants. Married participants provided greater percentage of neutral responses. In

case of professionally experienced groups, group 3 has shown highest percentage of

positive responses. Professionals of group 2 have shown highest percentage of negative

responses while group 4 appears to be most neutral in response to the statement.

Participants having different professional experience of different years provide highly

significant results.

113

Table 4.66:


(Verbal expression (tone, pitch) of patient effects decision of continuing the

communication)

Key Strongly

Agree


Disagree

Total

Frequency 76 110 45 9 3 243

Male 10.3% 18.9% 16.9% 11.9% 0.0% 58.0%

Female 6.6% 18.5% 10.3% 5.3% 1.2% 42.0%

Total 16.9% 37.4% 27.2% 27.2% 1.2% 100.0%





Table 4.67:



communication)

Key Strongly

Agree


Disagree

Total

Frequency 76 110 45 9 3 243

Single 7.4% 17.7% 4.1% 2.9% 1.2% 33.3%

Married 23.9% 27.6% 14.4% 0.8% 0.0% 66.7%

Total 31.3% 45.3% 18.5% 3.7% 1.2% 100.0%



statement against 25 % of singles. On the other side 1% of the married disagree with the

114

statement while the single who are 4% of the total. Chi-square shows the difference to be

significant.

Table 4.68:



communication)

Key Strongly

Agree


Disagree

Total

Frequency 68 112 38 10 15 243

1-5 years 14.0% 16.9% 5.3% 2.9% 0.0% 39.1%

6-10 years 5.8% 10.7% 4.1% 0.0% 1.2% 21.8%

11-15 yrs 4.1% 4.9% 0.0% 0.0% 0.0% 9.1%

More than

16 years

7.4% 12.8% 9.1% 0.8% 0.0% 30.0%

Total 31.3% 45.3% 18.5% 3.7% 1.2% 100%



disagree having 3 % belong to group 1 of professional experience. 9 % of those who are


chi-square.

Discussion (SP 21):

Overall, greater majority of participants agree to the statement that verbal

expression (tone, pitch) of patient effects decision of continuing the communication. In

sex-based responses, greater positive response comes from female participant while

highest percentage of positive responses comes from male participants. In neutral

response to the statement, males have higher percentage compared with males. In positive

responses to statement, gender difference remains unimportant but in neutral and negative

responses significant difference can be observed. The single participants give a greater

115

percentage of moderate positive response while married participants have shown highest

percentage of highly positive response. A significant difference in neutral response of

singles and married participants is shown in table 4.66 however married participants of

the research show highest percentage of neutral response. Participants with 11-15 years

of professional experience show highest percentage of positive response while people of

group 1 show highest percentage of negative percentage. The greater percentage of

neutral responses is shown by participants belonging to group 4 of professionals.

Difference in responses of different group is highly significant.

Table 4.69:


(The quality of doctors’ voice is also important for clear communication)

Key Strongly

Agree


Disagree

Total

Frequency 63 101 48 15 16 243

Male 14.8% 23.0% 12.3% 3.7% 4.1% 58.0%

Female 11.1% 18.5% 7.4% 2.5% 2.5% 42.0%

Total 25.9% 41.6% 19.8% 6.2% 6.6% 100.0%




5 % of the female in total. Chi-square shows the difference to be insignificant.

116

Table 4.70:



Key Strongly

Agree


Disagree

Total

Frequency 63 101 48 15 16 243

Single 9.1% 14.4% 5.3% 2.1% 2.5% 33.3%

Married 16.9% 27.2% 14.4% 4.1% 4.1% 66.7%

Total 25.9% 41.6% 19.8% 6.2% 6.6% 100.0%



statement against 24 % of the singles. On the other side 8% of the married disagree with


be significant.

Table 4.71:



Key Strongly

Agree


Disagree

Total

Frequency 63 101 48 15 16 243

1-5 years 9.5% 17.3% 4.9% 6.2% 1.2% 39.1%

6-10 years 4.1% 10.3% 2.1% 0.0% 5.3% 21.8%

11-15 yrs 3.3% 2.5% 3.3% 0.0% 0.0% 9.1%

More than

16 years

9.1% 11.5% 9.5% 0.0% 0.0% 30.0%

Total 25.9% 41.6% 19.8% 6.2% 6.6% 100%


117

21% of those who agree have more than 16 years of professional experience and

those who disagree having 8% belong to group 1 of professional experience. 5% of those

who are uncertain belong to group 1. The difference is highly significant as shown by the


Discussion (SP 22):

It can be seen that majority of the participants agree to the statement that the

quality of doctors‟ voice is also important for clear communication. In positive response

to the given statement gender difference remains unimportant however in positive

response greater percentage of females has shown strongly positive response while

greater percentage of males has shown greater negative and moderately negative

responses. The male participants have showed highest percentage of neutral responses.

The difference is responses of both genders is insignificant and can be ignored. A

significant variation of responses can be seen in data gathered from married and single

participants. Highest percentage of positive responses is gathered from single participants

similarly single participants have shown highest percentage of negative responses. In

neutral responses married participants have greater percentage compared with singles. In

negative and positive responses two groups show significant difference. Participants of

group 4 show highest percentage of agreement to the statement however greater negative

responses are shown by participants of group 2. Professional experience of the

participants emerged as a highly significant indicator to test the statement SP 22 and table

4.71 shows variation in responses of different groups of professionals.

118

IV Listening Comprehension (LC23-LC26)

Table 4.72:


(Listening attentively creates a partnership between doctor and patient)

Key Strongly

Agree


Disagree

Total

Frequency 112 103 8 12 8 243

Male 25.1% 25.5% 2.1% 2.5% 2.9% 58.0%

Female 21.0% 16.9% 1.2% 2.5% 0.4% 42.0%

Total 46.1% 42.4% 3.3% 4.9% 3.3% 100.0%




3% of the females. Chi-square shows the difference to be insignificant.

Table 4.73:



Key Strongly

Agree


Disagree

Total

Frequency 112 103 8 12 8 243

Single 19.3% 11.5% 1.6% 0.0% 0.8% 33.3%

Married 26.7% 30.9% 1.6% 4.9% 2.5% 66.7%

Total 46.1% 42.4% 3.3% 4.9% 3.3% 100.0%




119

the statement while the singles who are 1% of the total. Chi-square shows the difference

to be significant.

Table 4.74:



Key Strongly

Agree


Disagree

Total

Frequency 112 103 8 12 8 243

1-5 years 20.2% 14.4% 0.0% 1.2% 3.3% 39.1%

6-10 years 7.4% 11.5% 1.6% 1.2% 0.0% 21.8%

11-15 yrs 3.3% 2.5% 0.8% 2.5% 0.0% 9.1%

More than

16 years

15.2% 14.0% 0.8% 0.0% 0.0% 15.2%

Total 46.1% 42.4% 3.3% 4.9% 3.3% 100%


30% of those who agree have16 years of professional experience and those who

disagree having 5% belong to group 1 of professionals. 2 % of those who are uncertain


square.

Discussion (LC 23):

Table 4.72 shows responses of participants to statement that listening attentively

creates a partnership between doctor and patient. Highest percentage of neutral responses

comes from the male participants of the research however females show higher

percentage of positive response. In negative responses greater percentage of male

participants has shown negative response compared with females, but the difference in

percentages of females and male‟s response is negligible and remains unimportant. So

difference in gender-based responses is insignificant and can be ignored. Comparing

responses of married and single participants, single participants have shown higher

120

percentage of positive responses compared to males while greater percentage of married

participants has shown greater percentage of negative responses. The percentage of

neutral responses is significant which have higher ration of singles compare with married

participants. Difference in negative responses of married and single participants appears

to be a significant indicator to show that listening attentively creates a partnership

between doctor and patient. Professional experience of participants has highly significant

results and variation in responses is shown in table 4.74. In case of positive responses,

highest percentage of positive responses comes from participants having professional

experience of more than 16 years while highest percentage of negative responses to the

statement come form participants at the start of career with professional experiences of

11-15 years. Participants of group 3 show highest percentage of neutral responses.

Table 4.75:


(Doctor’s disinclination to listen to the patient affects the quality of doctor-patient

communication)

Key Strongly

Agree


Disagree

Total

Frequency 76 111 27 29 0 243

Male 17.3% 25.9% 7.4% 7.4% 0% 58.0%

Female 14.0% 19.8% 3.7% 4.5% 0% 42.0%

Total 31.3% 45.7% 11.1% 11.9% 0% 100.0%



statement against 34% of the female. On the other side 7% of the male disagree against


121

Table 4.76:



communication)

Key Strongly

Agree


Disagree

Total

Frequency 76 111 27 29 0 243

Single 13.2% 14.4% 4.9% 0.8% 0% 33.3%

Married 18.1% 31.3% 6.2% 11.1% 0% 66.7%

Total 31.3% 45.7% 11.1% 11.9% 0% 100.0%



statement against 28% of the single. On the other side 11% of the married disagree with


be significant.

Table 4.77:



communication)

Key Strongly

Agree


Disagree

Total

Frequency 76 111 27 29 15 243

1-5 years 16.0% 16.5% 4.1% 2.5% 0% 39.1%

6-10 years 4.5% 10.3% 0.8% 6.2% 0% 21.8%

11-15 yrs 4.1% 4.9% 0.0% 0.0% 0.0% 9.1%

More than

16 years

6.6% 14.8% 6.2% 2.5% 0.0% 30.0%

Total 31.3% 45.7% 11.1% 11.9% 0% 100%


122

9 % of those who agree have 11-15 years of professional experience and those

who disagree having 6% belong to group 2 of professional experience. 6 % of those who

are uncertain belong to group 4. The difference is highly significant as shown by the


Discussion (LC 24):


doctor‟s disinclination to listen to the patient affects the quality of doctor-patient medical

discourse. On average highest percentage of positive response is shown by the female

participants as compared to males. The male participants gave most neutral responses; the

male participants show greater percentage of negative response. However, the difference

in neutral, positive and negative response of male and females is insignificant.

Comparing responses of married and single participants, highest percentage of positive

response is shown by single participants; highest percentage of neutral response comes

form the single participants of the research group. Significantly high percentage of

married participants does not agree to the statement. The difference in responses of males

and females is significant. Interestingly a greater percentage of professionals with 11-15

years of professional experience show highest percentage of positive response and agree

to the statement LC 24. However, participants of group 4 have shown highest percentage

of neutral response. In negative responses to the statement, highest percentage is of group

2 professionals. Once again variations in responses of professional groups turn out to be a


123

Table 4.78:


(Preoccupations such as eating, drinking or doing handiwork divide attention which

mars the listening)

Key Strongly

Agree


Disagree

Total

Frequency 77 84 43 33 6 243

Male 17.3% 18.5% 11.9% 9.1% 1.2% 58.0%

Female 14.4% 16.0% 5.8% 4.5% 1.2% 42.0%

Total 31.7% 34.6% 17.7% 13.6% 2.5% 100.0%





Table 4.79:



mars the listening)

Key Strongly

Agree


Disagree

Total

Frequency 77 84 43 33 6 243

Single 13.6% 14.0% 3.7% 2.1% 0.0% 33.3%

Married 18.1% 20.6% 14.0% 11.5% 2.5% 66.7%

Total 31.7% 34.6% 17.7% 13.6% 2.5% 100.0%




124

the statement while the single who are 2 % of the total. Chi-square shows the difference

to be significant.

Table 4.80:



mars the listening)

Key Strongly

Agree


Disagree

Total

Frequency 77 84 43 33 6 243

1-5 years 13.2% 17.7% 4.1% 4.1% 0.0% 39.1%

6-10 years 7.8% 2.9% 7.0% 4.1% 0.0% 21.8%

11-15 yrs 0.0% 4.9% 1.6% 0.0% 2.5% 9.1%

More than

16 years

10.7% 9.1% 4.9% 5.3% 0.0% 30.0%

Total 31.7% 34.6% 17.7% 13.6% 2.5% 100%



disagree having 4 % belong to group 2 of professionals. 7% of those who are uncertain


square.

Discussion (LC 25):

In response to statement that pre-occupations such as eating, drinking or doing

handiwork divide attention, which mars the listening, the female participants of the

research show highest percentage of positive response. Males have provided highest

percentage of moderately and highly negative responses. The difference in positive

responses of both genders is insignificant. A greater percentage of males remained

neutral in response to the statement. Comparing the results from married and single

participants, greater percentage of strong and moderate responses is shown by the single

125

participants compared with married participants. Married participants have shown more

disagreement to the statement and the difference in negative responses of single and

married participants appears to be significant. Most of married participants remained

neutral to the statement compared with singles. The difference in responses of married

and unmarried people is significant and cannot be ignored. Data gathered from different

groups of professionals provides highly significant results and most varied responses.

Group 1 having least experienced people in the group shows highest percentage of

positive responses (table 4.80). On comparing neutral responses of all group highest

percentage of neutral responses are shown by group 2 professionals. Group 3

professionals with experience of 11-15 years have provided highest percentage of

negative responses.

Table 4.81:


(Poor hearing of patients is a barrier to effective listening for doctors)

Key Strongly

Agree


Disagree

Total

Frequency 68 112 38 10 15 243

Male 18.9% 23.5% 9.5% 2.1% 4.1% 58.0%

Female 9.1% 22.6% 6.2% 2.1% 2.1% 42.0%

Total 28.0% 46.1% 15.6% 4.1% 6.2% 100.0%





126

Table 4.82:



Key Strongly

Agree


Disagree

Total

Frequency 73 117 36 12 5 243

Single 7.4% 21.0% 2.9% 0.0% 2.1% 33.3%

Married 22.6% 27.2% 11.9% 4.9% 0.0% 66.7%

Total 30.0% 48.1% 14.8% 4.9% 2.1% 100.0%





be significant.

Table 4.83:



Key Strongly

Agree


Disagree

Total

Frequency 73 117 36 12 5 243

1-5 years 10.3% 23.5% 4.1% 0.0% 1.2% 39.1%

6-10 years 6.6% 10.3% 4.1% 0.0% 0.8% 21.8%

11-15 yrs 4.1% 4.9% 0.0% 0.0% 0.0% 9.1%

More than

16 years

9.1% 9.5% 6.6% 4.9% 0.0% 30.0%

Total 30.0% 48.1% 14.8% 4.9% 2.1% 100%


127




chi-square.

Discussion (LC 26):

In positive responses to statement that poor hearing of patients is a barrier to

effective listening for doctors, highly positive responses are collected from the female

participants compared with males. There is insignificant difference in positive responses

gathered from male and female participants however the male and female participants

show equal percentage of negative responses. Majority of male remained neutral in

response to the statement. In positive responses, single participants show highest

percentage of agreement with the statement. Married participants have shown higher

percentage of negative responses than singles. A significant difference can be seen in the

neutral response to the statement where married participants have higher percentage of

neutral response compared to singles. Difference turns out to be most prominent indicator

in variation to LC 26. Group 3 show highest percentage of positive responses while

highest percentage of negative responses comes from group 4. Professionals of group 4

showed maximum percentage of neutral responses. Overall, professional experience of

participants provides highly significant results and professional experience works as a

good indicator to test the statement.

128

V. Jargon /Medical Terminology (JT 27-JT 30)

Table 4.84:


(The medical terminology used by doctors’ act as a barrier in doctor-patient

communication)

Key Strongly

Agree


Disagree

Total

Frequency 52 117 27 32 15 243

Male 13.6% 28.0% 4.5% 7.8% 4.1% 58.0%

Female 7.8% 20.2% 6.6% 5.3% 2.1% 42.0%

Total 21.4% 48.1% 11.1% 13.2% 6.2% 100.0%



statement against 28 % of the female. On the other side 12% of the male disagree against


Table 4.85:


(The medical terminology used by doctors act as a barrier in doctor-patient

communication)

Key Strongly

Agree


Disagree

Total

Frequency 52 117 27 32 15 243

Single 7.8% 18.9% 3.3% 1.2% 2.1% 33.3%

Married 13.6% 29.2% 7.8% 11.9% 4.1% 66.7%

Total 21.4% 48.1% 11.1% 13.2% 6.2% 100.0%


129




be highly significant.

Table 4.86:


(The medical terminology used by doctors act as a barrier in doctor-patient

communication)

Key Strongly

Agree


Disagree

Total

Frequency 52 117 27 32 15 243

1-5 years 7.0% 19.3% 4.5% 7.0% 1.2% 39.1%

6-10 years 3.7% 8.2% 3.7% 1.2% 4.9% 21.8%

11-15 yrs 1.6% 2.5% 0.8% 4.1% 0.0% 9.1%

More than

16 years

9.1% 18.1% 2.1% 0.8% 0.0% 30.0%

Total 21.5% 48.1% 11.1% 13.2% 6.2% 100%


In total 27% of professional experience group 4 agree with the given statement.

On the other side those who disagree are 8% from professionals group 1, 6% of group 2

and 4% of group 3. Chi-square shows the difference to be highly significant.

Discussion (JT 27):


medical terminology used by doctors act as a barrier in doctor-patient medical discourse.

In positive response to the given statement gender difference remains unimportant

however in positive response greater percentage of males has shown strongly positive

response; greater percentage of males has shown greater negative and moderately

negative responses. The female participants have showed highest percentage of neutral

130

responses. The difference is responses of both genders is insignificant and can be

ignored. A highly significant variation of responses can be seen in data gathered from

married and single participants (table 4.85). Highest percentage of positive responses is

gathered from single participants however married participants show the highest

percentage of negative responses. In neutral responses, married participants have higher

percentage. In negative and neutral responses two groups show highly significant

difference. The professional experience of participants shows a relationship with

understanding that the medical terminology used by doctors act as a barrier in doctor-

patient medical discourse. Participants of group 4 show highest percentage of agreement

to the statement however greater negative responses are shown by participants of group 3.

Professional experience of the participants emerged as a highly significant indicator to

test the statement JT 27 and table 4.85 shows variation in responses of different groups of

professionals.

Table 4.87:


(Patients often fail to understand the meaning of jargon)

Key Strongly

Agree


Disagree

Total

Frequency 67 124 37 9 6 243

Male 15.2% 34.6% 5.8% 2.5% 15.2% 58.0%

Female 12.3% 16.5% 9.5% 1.2% 2.5% 42.0%

Total 27.5% 51.1% 15.3% 3.7% 17.7% 100.0%




4% of the female in total. Chi-square shows the difference to be significant.

131

Table 4.88:



Key Strongly

Agree


Disagree

Total

Frequency 67 124 37 9 6 243

Single 9.9% 18.9% 2.5% 0.8% 1.2% 33.3%

Married 17.7% 32.1% 12.8% 2.9% 1.2% 66.7%

Total 27.6% 51.0% 15.2% 3.7% 2.5% 100.0%





be significant.

Table 4.89:



Key Strongly

Agree


Disagree

Total

Frequency 67 124 27 29 9 243

1-5 years 14.0% 19.8% 2.9% 0.0% 2.5% 39.1%

6-10 years 4.5% 10.7% 5.8% 0.8% 0.0% 21.8%

11-15 yrs 0.0% 4.9% 2.5% 1.6% 0.0% 9.1%

More than

16 years

9.1% 15.6% 4.1% 1.2% 0.0% 30.0%

Total 27.6% 51.0% 11.1% 11.9% 3.7% 100%


132

In total 34 % of professional experience group 1 agree with the given statement

while it is 15% of group 2 and 25 % of group 4. On the other side those who disagree

have 2% of professional experience group 3, 3% of group 1 and 1% of group 4. Chi-

square shows the difference to be highly significant.

Discussion (JT 28):

Majority of male participants show an agreement to the statement that patients

often fail to understand the meaning of jargon however majority of females remained

neutral to the statement as they are not certain sure whether patients often fail to

understand the meaning of jargon or not. The female participants of the project provide

highest percentage of negative responses. The difference in responses of both genders is

significant and cannot be ignored. Single participants agree with the statement in

majority. The percentage of neutral responses is significant which have higher ratio of

married participants compared with singles. In negative response to the given statement

gender difference remains unimportant however in positive response greater percentage

of singles has shown positive response similarly greater percentage of single participants

have shown greater percentage of negative responses. The professional experience has

emerged as a highly significant indicator to about the use of medical jargons by doctors.

The percentage of neutral responses is highly significant across different groups of

professionals. In positive response greater percentage of group 1 professionals has shown

strongly positive response while group 3 professionals have shown greater percentage of

moderately positive responses. The group 3 professionals show highest percentage of

neutral and negative responses. The differences in neutral and negative responses of

different group appear to be highly significant.

133

Table 4.90:


(Jargon acts as harmful indicator for medical treatment of a patient)

Key Strongly

Agree


Disagree

Total

Frequency 53 98 40 43 9 243

Male 10.7% 25.1% 10.3% 9.9% 2.1% 58.0%

Female 11.1% 15.2% 6.2% 7.8% 1.6% 42.0%

Total 21.8% 40.3% 16.5% 17.7% 3.7% 100.0%





Table 4.91:



Key Strongly

Agree


Disagree

Total

Frequency 53 98 40 43 9 243

Single 7.8% 16.5% 4.5% 4.5% 0.0% 33.3%

Married 14.0% 23.9% 11.9% 13.2% 3.7% 66.7%

Total 21.8% 40.3% 16.5% 17.7% 3.7% 100.0%





be significant.

134

Table 4.92:



Key Strongly

Agree


Disagree

Total

Frequency 53 98 40 43 9 243

1-5 years 9.5% 16.0% 3.7% 6.2% 3.7% 39.1%

6-10 years 3.7% 5.3% 7.0% 5.8% 0.0% 21.8%

11-15 yrs 2.5% 6.6% 0.0% 0.0% 0.0% 9.1%

More than

16 years

6.2% 12.3% 5.8% 5.8% 0.0% 30.0%

Total 21.8% 40.3% 16.5% 17.7% 3.7% 100%


In t6otal 9 % of professional experience group 3 agree with the given statement

while it is 25% of group 1 and 19% of group 4. On the other side those who disagree

have 6% of professional experience group 2, 10% of group 1 and 6% of group 4. Chi-

square shows the difference to be highly significant.

Discussion (JT 29):

Results demonstrate that jargon acts as harmful indicator for medical treatment of

patient. Females show highest percentage of positive responses compare with males. The

difference in highly positive and moderately positive responses of both genders is

insignificant and can be ignored. Greater percentage of negative responses comes from

females while males have less percentage of negative responses. Male participants show

higher percentages in neutral responses to the statement. Difference in neutral, positive

and negative responses of both genders is insignificant. On comparing results of marital

status-based variation, difference in responses of married and single participants is

significant. Significantly varied negative responses can be seen in table 4.91. The single

participants show highest percentage of positive responses while highest percentage of

negative responses comes from the married participants. Married participants have shown

135

greater percentage of neutral responses. In case of professionally experienced groups,

group 3 has shown highest percentage of positive responses. Professionals of group 3

have shown highest percentage of negative responses; group 3 shows highest percentage

of neutral responses to the statement. Participants having different professional

experience provide highly significant results.

Table 4.93:


(The medical terminology creates miscommunication if used frequently)

Key Strongly

Agree


Disagree

Total

Frequency 73 87 45 32 6 243

Male 18.9% 21.4% 11.5% 6.2% 0.0% 58.0%

Female 11.1% 14.4% 7.0% 7.0% 2.5% 42.0%

Total 30.0% 35.8% 18.5% 13.2% 2.5% 100.0%





Table 4.94:



Key Strongly

Agree


Disagree

Total

Frequency 73 87 45 32 6 243

Single 9.5% 16.5% 3.7% 2.5% 1.2% 33.3%

Married 20.6% 19.3% 14.8% 10.7% 1.2% 66.7%

Total 30.0% 35.8% 18.5% 13.2% 2.5% 100.0%


136




be significant.

Table 4.95:

Professional experience -based variation in the responses Questionnaire item 30


Key Strongly

Agree


Disagree

Total

Frequency 73 87 45 32 6 243

1-5 years 10.3% 18.1% 5.3% 2.9% 2.5% 39.1%

6-10 years 4.1% 4.9% 8.6% 4.1% 0.0% 21.8%

11-15 yrs 1.6% 7.4% 0.0% 0.0% 0.0% 9.1%

More than

16 years

14.0% 5.3% 4.5% 6.2% 0.0% 30.0%

Total 30.0% 35.8% 18.5% 13.2% 2.5% 100%


In total 9 % of professional experience group 3 agree with the given statement

while it is 28% of group 1 and 19% of group 4. On the other side those who disagree

have 6% of professional experience group 4, and 4 % of group 2. Chi-square shows the

difference to be highly significant.

Discussion (JT 30):

Majority of participants agree with the statement that the medical terminology

creates miscommunication if used frequently. The male candidates give highest

percentage of positive responses however difference in positive responses of two genders

is insignificant. The male participants have given a higher percentage of neutral

responses. Female participants have shown greater percentage of negative responses.

137

Overall the difference in negative responses of two genders is significant. Table 4.94

shows the statistics gathered from married and single participants of the research and the

results demonstrate a strong agreement of the participants to the statement. A higher

percentage of strong positive responses come from single participants. Highest

percentage of neutral responses is from participants who are married. In negative

response to the given statement greater percentage of response comes from married

participants of the research. The difference in negative, positive and neutral responses of

married and single participants is significant. Thus professional experience shows

relationship with positive responses to the statement. In positive responses greater

percentage of group 4 of professionals has shown strong positive response; group 3

participants have shown highest percentage of moderate positive responses. Highly

significant difference in neutral and negative responses can be seen in table 4.95 however

highest percentage of negative response are recorded from participants of group 4. Like

previous discussion results, professionals show highly significant difference of response

and professional experience emerges as good indicator to study variation of responses.

VI. Gender (G 31-G35)

Table 4.96:


(Gender affects communication between doctor and patient)

Sex Strongly agree Agree Uncertain Disagree Strongly

disagree

Total

Freq

Male

62

31.2%

76

30.5%

54

19.1%

45

15.6%

6

3.5%

243

100%

Female 17.6% 32.4% 27.5% 21.6% 1.0% 100.0%

Total 25.5% 31.3% 22.6% 18.1% 2.5% 100.0%


The aggregate of the percentages of the males who agreed with the statement is

almost 62% against that of the females i.e. 50% while among those who disagreed almost

22% are females and 19% males. Value of chi-square is significant.

138

Table 4.97:

Marital status -based variation in the responses to Questionnaire item 31(Gender

affects communication between doctor and patient)

Marital Status Strongly

Agree


Disagree

Total

Frequency

Single

62

22.2%

76

43.2%

55

16.0%

44

14.8%

6

3.7%

243

100%

Married 27.2% 25.3% 25.9% 19.8% 1.9% 100%

Total 25.5% 31.3% 22.6% 18.1% 2.5% 100.0%


The aggregate of the percentages of the singles that agreed with the statement is

almost 65% against that of the married i.e. 52% while among those who disagreed almost

21% are married and 18% single. Chi-square shows the difference to be significant.

Table 4.98:


(Gender affects communication between doctor and patient)

Professional

Experience

Strongly

Agree


Disagree

Total

Frequency

1-5 years

62

20.0%

76

33.7%

55

18.9%

44

27.4%

6

0%

243

100.0%

6-10 years 45.3% 32.1% 11.3% 0% 11.3% 100.0%

11-15 years 45.5% 36.4% 18.2% 0% 0% 100.0%

16 years + 12.3% 26.0% 37.0% 24.7% 0% 100.0%

Total 25.5% 31.3% 22.6% 18.1% 2.5% 100.0%


The aggregate percentages of those who agreed with the statement show that 82%

belong to professional experience group 3, 77% to group 2, 54% to group 1 and 38% to

group 4. The aggregates of those who disagree have 27% from group 1, 25% from group

4 and 11% from group 2. The value of chi-square is significant.

139

Discussion (G 31):

The majority of participants agree to the statement that gender affects

communication between doctor and patient. In positive responses to the given statement

gender difference marital status and professional experience of the participants show

significant variation. Greater percentage of males has shown strongly positive and

moderately positive, responses as compared to females. The difference in percentages of

neutral responses is significant however the female participants show greater percentage

of neutral responses. In case of negative responses, females have shown greater

percentage of negative responses as compared to males. The difference in responses of

married and single participants is significant. Married participants have lower percentage

of positive responses, as compared to single participants but the difference of these

responses is significant. Married participants have shown greater percentage of

disagreement as compared with singles. Same difference can be observed in case of

negative responses where married participants have greater percentage of negative

responses. Highest percentage of strongly positive and moderately positive response is

from participants who have professional experience of 11-15 years while those who have

1-5 year experience give greater percentage of negative response. So responses show a

relationship with the professional experience of the participants. Thus professional

experience has emerged as a significant indicator of interest to know that gender affects

communication between doctor and patient.

Table 4.99:


(Female doctors are more caring and facilitate more dialogue between the patient

and the doctor)

Sex Strongly

agree


disagree

Total

Freq

Male

45

15.6%

48

12.1%

54

23.4%

51

24.8%

45

24.1%

243

100%

Female 22.5% 30.4% 20.6% 14.7% 11.8% 100%

Total 18.5% 19.8% 22.2% 20.6% 18.9% 100.0%


140

The aggregate of the percentages of the females who agreed with the statement is

almost 53% against that of the males i.e. 28% while among those who disagreed almost

49% are males and 27% females. Value of chi-square is highly significant.

Table 4.100:

Marital status -based variation in the responses to Questionnaire item 32 (Female

doctors are more caring and facilitate more dialogue between the patient and the

doctor)

Marital status Strongly

agree


disagree

Total

Frequency

Single

45

22.2%

48

30.9%

54

24.7%

51

9.9%

45

12.3%

243

100%

Married 16.7% 14.2% 21.0% 25.9% 22.2% 100%

Total 18.5% 19.8% 22.2% 20.6% 18.9% 100.0%


The aggregate of the percentages of the singles who agreed with the statement is


48% are married and 22% single. Chi-square shows the difference to be highly

significant.

Table 4.101:


(Female doctors are more caring and facilitate more dialogue between the patient

and the doctor)

Professional

Experience

Strongly

Agree


Disagree

Total

Frequency

1-5 years

45

16.8%

48

31.6%

54

14.7%

51

18.9%

45

17.9%

243

100.0%

6-10 years 24.5% 15.1% 20.8% 9.4% 30.2% 100.0%

11-15 years 45.5% 0.0% 9.1% 18.2% 27.3% 100.0%

16 years + 8.2% 13.7% 37.0% 31.5% 9.6% 100.0%

Total 18.5% 19.8% 22.2% 20.6% 18.9% 100.0%



belong to professional experience group 1, 45 % to group 3, 40% to group 2 and 22% to

141


4, 40 % from group 2 and 36 % from group 1. The value of chi-square is significant.

Discussion (G 32):

Majority of participants affirm that female doctors are more caring and facilitate

more dialogue between the patient and the doctor. In positive responses to the given

statement gender differences remain very important however in positive responses greater

percentage of females has shown greatly positive response as compare to males. The

percentage of neutral responses has higher ratio from male participants compared with

females; the percentage of negative response has higher ration from male participants.

The difference in male and female responses is highly significant. Marital status of the

participants turn out to be another good indicator for knowing that female doctors are

more caring and facilitate more dialogue between the patient and the doctor, table 4.100

shows highly significant differences in responses of married and single participants.

Highest percentage of single participants has greatly positive and moderately positive

responses as compared to married. Married people showed highest percentage of negative

responses while singles have shown higher percentage of neutral responses. The

difference in neutral responses of married or single participants is highly significant.

Professional experience of participants has emerged as a significant indicator to show that

female doctors are more caring and facilitate more dialogue between the patient and the

doctor. Highest percentage of positive and negative responses is observed from

participants who have 11-15 year of experience. Professionals of group 4 have highest

percentage of neutral responses. Thus professional experience shows significant variation

in opinion of participants with varied professional experiences.

142

Table 4.102:


(Female doctors prefer a more personal, close setting for communicating)

Sex Strongly

agree


disagree

Total

Freq

Male

35

15.6%

88

33.3%

70

29.8%

28

9.9%

22

11.3%

243

100%

Female 12.7% 40.2% 27.5% 13.7% 5.9% 100%

Total 14.4% 36.2% 28.8% 11.5% 9.1% 100.0%




19% are females and 21% males. Value of chi-square is insignificant.

Table 4.103:

Marital status-based variation in the responses to Questionnaire item 33 (Female

doctors prefer a more personal, close setting for communicating)

Marital status Strongly

agree


disagree

Total

Frequency

Single

35

19.8%

88

35.8%

70

27.2%

28

11.1%

22

6.2%

243

100%

Married 11.7% 36.4% 29.6% 11.7% 10.5% 100%

Total 14.4% 36.2% 28.8% 11.5% 9.1% 100.0%


The aggregate of the percentages of the singles that agreed with the statement is


22% are married and 17% single. Chi-square shows the difference to be insignificant.

143

Table 4.104:


(Female doctors prefer a more personal, close setting for communicating)

Professional

Experience

Strongly

Agree


Disagree

Total

Frequency

1-5 years

35

18.9%

88

37.9%

70

24.2%

28

9.5%

22

9.5%

243

100.0%

6-10 years 13.2% 45.3% 18.9% 5.7% 17.0% 100.0%

11-15 years 27.3% 54.5% 18.2% 0% 0% 100.0%

16 years + 5.5% 21.9% 45.2% 21.9% 5.5% 100.0%

Total 14.4% 36.2% 28.8% 11.5% 9.1% 100.0%


The aggregate percentages of those who agreed with the statement show that 82

% belong to professional experience group 3, 59 % to group 2, 57 % to group 1 and 27 %

to group 4. The aggregates of those who disagree have 27 % from group 4, 23 % from

group 2, 19 % from group 1 and 0 % from group 3. The value of chi-square is significant.

Discussion (G 33):

Responses of male and female participants to G 33 shows an agreement to the

statement, that female doctors prefer a more personal, close setting for communicating.

Keeping in view sex-based variation of responses, highest percentage of positive

responses comes from the female participants as compared to positive responses from

males however in negative responses; percentage of male responses is higher than

females. In neutral responses percentage of male participants is higher than females. In

positive or negative responses to G 33 (as shown in table 4.102), gender difference

remains unimportant and the difference in responses is insignificant. Comparing results

obtained from married and single participants show that majority of single participants

agree with the statement of issue. On the contrary, highest percentage of negative

responses comes from married participants. It is interesting to know that highly negative

responses come from married people while single and married participants have equal

percentage of moderately negative responses. Overall difference of responses in

responses of married and single participants is insignificant. Professional experience

turns out to be important indicator to know about statement given in G 33. Highest

percentage of positive responses comes from participants having experience of mere than

16 years experience. Highest percentage of negative responses comes from people with

144

11-15 years of professional experience. Group 4 of participants shows highest percentage

of neutral responses. Professional experience appears to be a good indicator to see the

difference of opinions, as the results are significant.

Table 4.105:


(Female patients ask more questions than male patients)

Sex Strongly

Agree


Disagree

Total

Freq

Male

68

22.7%

50

23.4%

61

24.1%

52

27.0%

12

2.8%

243

100%

Female 35.3% 16.7% 26.5% 13.7% 7.8% 100%

Total 28.0% 20.6% 25.1% 21.4% 4.9% 100.0%



almost 52% against that of the males i.e. 46 % while among those who disagreed almost

30% are males and 22% females. Value of chi-square is significant.

Table 4.106:

Marital status-based variation in the responses to Questionnaire item 34 (Female

patients ask more questions than male patients)


Agree


Disagree

Total

Frequency

Single

69

28.4%

66

27.2%

57

23.5%

36

14.8%

15

6.2%

243

100%

Married 27.8% 17.3% 25.9% 24.7% 4.3% 100%

Total 28.4% 27.2% 23.5% 14.8% 6.2% 100.0%


145

The aggregate of the percentages of the single who agreed with the statement is



Table 4.107:


(Female patients ask more questions than male patients)

Professional

Experience

Strongly

Agree


Disagree

Total

Frequency

1-5 years

68

30.5%

50

24.2%

61

13.7%

52

26.3%

12

5.3%

243

100.0%

6-10 years 30.2% 7.5% 22.6% 34.0% 5.7% 100.0%

11-15 years 27.3% 9.1% 36.4% 27.3% 0% 100.0%

16 years + 23.3% 28.8% 38.4% 4.1% 5.5% 100.0%

Total 28.0%` 20.6% 25.1% 21.4% 4.9% 100.0%






Discussion (G 34):

Table 4.105 shows responses of participants to statement that female patients ask

more questions than male patients. Highest percentage of neutral responses comes from

female participants of the research similarly females show higher percentage of positive

response. In negative responses greater percentage of male participants has shown

negative response compared with females and the difference in percentages of females

and male‟s response is significant and cannot be ignored. Comparing responses of

married and single participants, single participants have shown higher percentage of

positive responses compared to males while greater percentage of married participants

has shown greater percentage of negative responses. In neutral responses a greater

percentage of married participants remained neutral compared with single participants.

Professional experience of participants has significant results and variation in responses

146

is shown in table 4.107. In case of positive responses, highest percentage of positive

responses comes from participants having professional experience of 1-5 years while

highest percentage of negative responses to the statement come form participants of

group 3. Participants of group 4 show highest percentage of neutral responses.

Table 4.108:


(Male doctors spend more time in interviewing female patients than male patients)

Sex Strongly

Agree


Disagree

Total

Freq

Male

27

12.8%

39

12.1%

79

32.6%

46

17.7%

52

24.8%

243

100%

Female 8.8% 21.6% 32.4% 20.6% 16.7% 100%

Total 11.1% 16.0% 32.5% 18.9% 21.4% 100.0%




42% are males and 37% females. Value of chi-square is insignificant.

Table 4.109:

Marital status -based variation in the responses to Questionnaire item 35 (Male

doctors spend more time in interviewing female patients than male patients)

Marital

Status

Strongly

Agree


Disagree

Total

Frequency

Single

27

19.8%

39

22.2%

79

24.7%

46

6.2%

52

27.2%

243

100%

Married 6.8% 13.0% 36.4% 25.3% 18.5% 100%

Total 11.1% 16.0% 32.5% 18.9% 21.4% 100.0%


147


almost 42% against that of the married i.e. 20 % while among those who disagreed

almost 44% are married and 33 % single. Chi-square shows the difference to be

significant.

Table 4.110:


(Male doctors spend more time in interviewing female patients than male patients)

Professional

Experience

Strongly

Agree


Disagree

Total

Frequency

1-5 years

27

14.7%

39

21.1%

79

23.2%

46

16.8%

52

24.2%

243

100.0%

6-10 years 9.4% 11.3% 35.8% 20.8% 22.6% 100.0%

11-15 years 0% 18.2% 36.4% 45.5% 0% 100.0%

16 years + 11.0% 12.3% 41.1% 12.3% 23.3% 100.0%

Total 11.1% 16.0% 32.5% 18.9% 21.4% 100.0%






Discussion (G 35):

In response to statement that the male doctors spend more time in interviewing

female patients than male patients, the female participants of the research show highest

percentage of positive response. Males have provided highest percentage of negative

responses. The difference in positive responses of both genders is insignificant. A greater

percentage of males remained neutral in response to the statement. Comparing the results

from married and single participants, greater percentage of strong and moderate positive

responses is shown by the single participants compared with married participants.

148

Married participants have shown higher disagreement to the statement and the difference

in negative responses of single and married participants appears to be significant. Most of

married participants remained neutral to the statement compared with singles. The

difference in responses of married and unmarried people is significant and cannot be

ignored. Data gathered from different groups of professionals provides significant results.

Group 1 having least experienced people in the group shows highest percentage of

positive responses (table 4.110). On comparing neutral responses of all group highest

percentage of neutral responses are shown by group 4 professionals. Group 3

professionals with experience of 11-15 years have provided highest percentage of

negative responses.

VII. Personality (P 36-P41)

Table 4.111:


(Doctors don't communicate well due to their personality)

Sex Strongly

agree


disagree

Total

Freq

Male

51

27.0%

48

17.7%

64

23.4%

55

25.5%

25

6.4%

243

100%

Female 12.7% 22.5% 30.4% 18.6% 15.7% 100%

Total 21.0% 19.8% 26.3% 22.6% 10.3% 100.0%





149

Table 4.112:


don't communicate well due to their personality)


Agree


Disagree

Total

Frequency

Single

51

18.5%

48

35.8%

64

19.8%

55

16.0%

25

9.9%

243

100%

Married 22.2% 11.7% 29.6% 25.9% 10.5% 100%

Total 21.0% 19.8% 26.3% 22.6% 10.3% 100.0%


„




Table 4.113:


(Doctors don't communicate well due to their personality)

Professional

Experience

Strongly

Agree


Disagree

Total

Frequency

1-5 years

51

17.9%

48

30.5%

64

13.7%

55

21.1%

25

16.8%

243

100.0%

6-10 years 24.5% 11.3% 32.1% 15.1% 17.0% 100.0%

11-15 years 63.6% 9.1% 18.2% 9.1% 0% 100.0%

16 years + 9.6% 15.1% 41.1% 34.2% 0% 100.0%

Total 21.0% 19.8% 26.3% 22.6% 10.3% 100.0%


150




4, 32% from group 2 and 9% from group 3. The value of chi-square is significant.

Discussion (P 36):


doctors don't communicate well due to their personality. On average highest percentage

of positive response is shown by the male participants as compared to females. The

female participants gave most neutral responses; the female participants show greater

percentage of negative response. However, the difference in neutral, positive and

negative response of male and females is insignificant. Comparing responses of married

and single participants, highest percentage of positive response is shown by single

participants; highest percentage of neutral response comes from married participants of

the research group. Significantly high percentage of married participants does not agree

to the statement. The difference in responses of males and females is significant.

Interestingly a greater percentage of professionals with 11-15 years of professional

experience show highest percentage of positive response and agree to the statement P 37.

However, participants of group 4 have shown highest percentage of neutral response. In

negative responses to the statement, highest percentage is of group 1 professionals. Once

again variation in responses of professional groups turns out to be a good indicator to test

the statement and the results are significant.

Table 4.114:


(Doctors need to be more kind, gentle, considerate, courteous, and respectful to

patients)

Sex Strongly

Agree


Disagree

Total

Freq

Male

95

42.6%

83

29.8%

27

14.2%

10

2.1%

28

11.3%

243

100%

Female 34.3% 40.2% 6.9% 6.9% 11.8% 100%

Total 39.1% 34.2% 11.1% 4.1% 11.5% 100.0%


151




Table 4.115:


need to be more kind, gentle, considerate, courteous, and respectful to patients)


Agree


Disagree

Total

Frequency

Single

95

35.8%

83

43.2%

27

13.6%

10

3.7%

28

3.7%

243

100%

Married 40.7% 29.6% 9.9% 4.3% 15.4% 100%

Total 39.1% 34.2% 11.1% 4.1% 11.5% 100.0%





152

Table 4.116:


(Doctors need to be more kind, gentle, considerate, courteous, and respectful to

patients)

Professional

Experience

Strongly

Agree


Disagree

Total

Frequency

1-5 years

95

31.6%

83

45.3%

27

10.5%

10

3.2%

28

9.5%

243

100.0%

6-10 years 30.2% 32.1% 0% 13.2% 24.5% 100.0%

11-15 years 45.5% 27.3% 0% 0% 27.3% 100.0%

16 years + 53.4% 23.3% 23.3% 0% 0% 100.0%

Total 39.1% 34.2% 11.1% 4.1% 11.5% 100.0%





3, 13% from group1 and 0% from group 4. The value of chi-square is significant.

Discussion (P37):

In positive response to the given statement gender difference remains important

however in positive response greater percentage of females has shown strongly positive

response; greater percentage of males has shown greater negative and moderately

negative responses. The male participants have showed highest percentage of neutral

responses. The difference is responses of both genders is significant and cannot be

ignored. Highest percentage of positive responses is gathered from single participants

however married participants show the highest percentage of negative responses. In

neutral responses, single participants have higher percentage. In negative and neutral

responses two groups show significant difference. Participants of group 1 show highest

percentage of agreement to the statement however greater negative responses are shown

by participants of group 2. Participants of group 4 gave most neutral responses.

153

Table 4.117:


(Doctors scold their patient during treatment/counseling)

Sex Strongly

Agree


Disagree

Total

Freq

Male

41

19.9%

84

37.6%

53

15.6%

35

12.1%

30

14.9%

243

100%

Female 11.8% 30.4% 30.4% 17.6% 9.8% 100%

Total 16.5% 34.6% 21.8% 14.4% 12.8% 100.0%





Table 4.118:


scold their patient during treatment/counseling)

Marital

Status

Strongly

Agree


Disagree

Total

Freque

ncy

Single

41

16.0%

84

39.5%

53

34.6%

35

3.7%

30

6.2%

243

100%

Married 16.7% 32.1% 15.4% 19.8% 16.0% 100%

Total 16.5% 34.6% 21.8% 14.4% 12.8% 100.0%





154

Table 4.119:


(Doctors scold their patient during treatment/counseling)

Professional

Experience

Strongly

Agree


Disagree

Total

Frequency

1-5 years

41

13.7%

84

37.9%

53

17.9%

35

17.9%

30

12.6%

243

100.0%

6-10 years 1.9% 35.8% 34.0% 9.4% 18.9% 100.0%

11-15 years 81.8% 9.1% 9.1% 0% 0% 100.0%

16 years + 11.0% 37.0% 21.9% 17.8% 12.3% 100.0%

Total 16.5% 34.6% 21.8% 14.4% 12.8% 100.0%



belong to professional experience group 3, 51% to group 1, 48% to group 4and 37% to



Discussion (P 38):

In positive responses to statement that doctors scold their patient during

treatment/counseling, highly positive responses are collected from the male participants

compared with females. There is a significant difference in positive responses gathered

from male and female participants and female participants show higher percentage of

negative responses. Majority of female remained neutral in response to the statement. In

positive responses, single participants show highest percentage of agreement with the

statement. Married participants have shown higher percentage of negative responses than

singles. A significant difference can be seen in the neutral response to the statement

where single participants have higher percentage of neutral response compared to

married. Difference turns out to be prominent indicator in variation of responses to P 38.

Group 3 show highest percentage of positive responses while highest percentage of

negative responses comes from group 1. Professionals of group 2 showed maximum

percentage of neutral responses. Overall, professional experience of participants provides

155

significant results and professional experience works as a good indicator to test the

statement.

Table 4.120:


(Negative attitude (rudeness, arrogance) of patient is a big hurdle in effective

communication)

Sex Strongly

Agree


Disagree

Total

Freq

Male

61

23.4%

105

46.8%

39

14.9%

36

14.9%

02

0%

243

100%

Female 27.5% 38.2% 17.6% 14.7% 2.0% 100%

Total 25.1% 43.2% 16.0% 14.8% 0.8% 100.0%





Table 4.121:

Marital status -based variation in the responses to Questionnaire item 39 (Negative

attitude (rudeness, arrogance) of patient is a big hurdle in effective

communication)

Marital

Status

Strongly

Agree


Disagree

Total

Frequency

Single

61

42.0%

105

35.8%

39

16.0%

36

6.2%

02

0%

243

100%

Married 16.7% 46.9% 16.0% 19.1% 1.2% 100%

Total 25.1% 43.2% 16.0% 14.8% 0.8% 100.0%


156



almost 20% are married and 6% single. Chi-square shows the difference to be significant.

Table 4.122:


(Negative attitude (rudeness, arrogance) of patient is a big hurdle in effective

communication)

Professional

Experience

Strongly

Agree


Disagree

Total

Frequency

1-5 years

61

44.2%

105

29.5%

39

11.6%

36

14.7%

02

0%

243

100.0%

6-10 years 5.7% 30.2% 35.8% 24.5% 3.8% 100.0%

11-15 years 0% 100.0% 0% 0% 0% 100.0%

16 years + 21.9% 53.4% 12.3% 12.3% 0% 100.0%

Total 25.1% 43.2% 16.0% 14.8% 0.8% 100.0%


The aggregate percentages of those who agreed with the statement show that

100% belong to professional experience group 3, 75% to group 4, 74% to group 1 and 36

% to group 2. The aggregates of those who disagree have 28% from group 2, 15% from

group 1, 12% from group4 and 0% from group 3. The value of chi-square is significant.

Discussion (P 39):


negative attitude (rudeness, arrogance) of patient is a big hurdle in effective

communication. However, the difference in neutral, positive and negative response of

genders is insignificant. On average highest percentage of positive response is shown by

the male participants as compared to females. The female participants have shown greater

percentage of negative and neutral response. Comparing responses of married and single

participants, single participants show highest percentage of positive and neutral

157

responses. There is a significant difference in responses of married and single

participants. Significantly high percentage of single participants does not agree to the

statement. A greater percentage of professionals with 11-15 years of professional

experience show overall highest percentage of positive response however highest

percentage of strong response is given by group 1. In negative response participants of

group 2 have highest percentage; significantly group 2 participants have highest

percentage of neutral responses. Once again variation in responses of professional groups

turns out to be a good indicator to test the statement and the results are significant.

Table 4.123:


(Greeting by the doctors makes patient feel comfortable)

Sex Strongly

Agree


Disagree

Total

Freq

Male

121

45.4%

77

34.8%

30

17.7%

12

2.1%

03

0%

243

100%

Female 55.9% 27.5% 4.9% 8.8% 2.9% 100%

Total 49.8% 31.7% 12.3% 4.9% 1.2% 100.0%





158

Table 4.124:

Marital-status -based variations in the responses to Questionnaire item 40 (Greeting

by the doctors makes patient feel comfortable)

Marital

Status

Strongly

Agree


Disagree

Total

Frequency

Single

121

43.2%

77

35.8%

30

13.6%

12

3.7%

03

3.7%

243

100%

Married 53.1% 29.6% 11.7% 5.6% 0% 100%

Total 49.8% 31.7% 12.3% 4.9% 1.2% 100.0%


The aggregate of the percentages of the single that agreed with the statement is


7% are single and 6% married. Chi-square shows the difference to be significant.

Table 4.125:


(Greeting by the doctors makes patient feel comfortable)

Professional

Experience

Strongly

Agree


Disagree

Total

Frequency

1-5 years

121

41.1%

77

36.8%

30

15.8%

12

6.3%

03

0%

243

100.0%

6-10 years 30.2% 41.5% 22.6% 0% 5.7% 100.0%

11-15 years 63.6% 9.1% 0% 27.3% 0% 100.0%

16 years + 71.2% 24.7% 4.1% 0% 0% 100.0%

Total 49.8% 31.7% 12.3% 4.9% 1.2% 100.0%



belong to professional experience group 4, 78% to group 1, 73% to group 3 and 72 % to

159



Discussion (P 40):

Tables 4.124-4.126 show responses of participants to statement that greeting by

the doctors‟ makes patient feel comfortable highest percentage of neutral responses

comes from the male participants of the research however females show higher

percentage of negative responses. In positive responses greater percentage of male

participants has shown positive responses compared with females, but the difference in

percentages of females and male‟s response is negligible and remains unimportant. So

difference in gender-based responses is insignificant and can be ignored. Comparing

responses of married and single participants, single participants have shown lower

percentage of positive responses compared to males while greater percentage of single

participants have shown greater percentage of negative and neutral responses. Difference

in negative responses of married and single participants appears to be a significant.

Professional experience of participants has highly significant results and variation in

responses is shown in table 4.126. In case of positive responses, highest percentage of

positive responses comes from participants having professional experience of more than

16 years while highest percentage of negative responses to the statement come form

participants having professional experiences of 11-15 years. Participants of group 2 show

highest percentage of neutral responses.

Table 4.126:


(Doctors encourage patients to ask questions)

Sex Strongly

Agree


Disagree

Total

Freq

Male

128

53.2%

62

25.5%

43

16.3%

10

5.0%

00

0%

243

100%

Female 52.0% 25.5% 19.6% 2.9% 0% 100%

Total 52.7% 25.5% 17.7% 4.1% 0% 100.0%


160




Table 4.127:


encourage patients to ask questions)

Marital

Status

Strongly

Agree


Disagree

Total

Freq

Single

128

49.4%

62

40.7%

43

9.9%

10

0%

00

0%

243

100%

Married 54.3% 17.9% 21.6% 6.2% 0% 100%

Total 52.7% 25.5% 17.7% 4.1% 0% 100.0%




6% are married and 0% single. Chi-square shows the difference to be highly significant.

Table 4.128:


(Doctors encourage patients to ask questions)

Professional

Experience

Strongly

Agree


Disagree

Total

Frequency

1-5 years

128

54.7%

62

29.5%

43

12.6%

10

3.2%

00

0%

243

100.0%

6-10 years 52.8% 32.1% 9.4% 5.7% 0% 100.0%

11-15 years 45.5% 0% 36.4% 18.2% 0% 100.0%

16 years + 52.1% 23.3% 24.7% 0% 0% 100.0%

Total 52.7% 25.5% 17.7% 4.1% 0% 100.0%


161


belong to professional experience group 1, 85 % to group 2, 76 % to group 4 and 46 % to

group 3. The aggregates of those who disagree have 18 % from group 3, 6% from group


Discussion (P 41):

The majority of participants agree to the statement that doctors encourage patients

to ask questions. In positive response, greater percentage of males has shown strongly

positive and moderately positive responses as compared to females. The difference in

percentages of neutral responses is insignificant. The male participants show greater

percentage of neutral responses. In case of negative responses, males have shown greater

percentage of negative responses as compared to females. The difference in responses of

married and single participants is highly significant. Married participants have lower

percentage of positive responses, as compared to single participants but the difference of

these responses is significant. Married participants have shown greater percentage of

disagreement as compared with singles. The married participants show a greater

percentage of neutral responses. Table 4.128 shows highly significant difference in

opinions of married and single participants of the research. Participants of group 1-2

professionals have shown highest percentages of strongly positive and moderately

positive responses. Those who have 11-15 year experience give greater percentage of

negative response. So responses show a relationship with the professional experience of

the participants. Thus professional experience has emerged as a significant indicator of

interest to know that doctors encourage patients to ask questions.

162

VIII. Location and Setting (LS 42 - 46)

Table 4.129:


(The noisy environment makes communication difficult)

Sex Strongly

Agree


Disagree

Total

Freq

Male

104

37.6%

80

36.9%

27

11.3%

13

2.8%

19

9.2%

243

100%

Female 50.0% 27.5% 7.8% 8.8% 5.9% 100%

Total 42.8% 32.9% 11.1% 5.3% 7.8% 100.0%




15 % are females and 12% males. Value of chi-square is significant.

Table 4.130:

Marital status-based variation in the responses to Questionnaire item 42 (The noisy

environment makes communication difficult)

Marital

Status

Strongly

Agree


Disagree

Total

Frequency

Single

104

42.0%

80

38.3%

27

8.6%

13

7.4%

19

3.7%

243

100%

Married 43.2% 30.2% 12.3% 4.3% 9.9% 100%

Total 42.8% 32.9% 11.1% 5.3% 7.8% 100.0%





163

Table 4.131:


(The noisy environment makes communication difficult)

Professional

Experience

Strongly

Agree


Disagree

Total

Frequency

1-5 years

104

43.2%

80

35.8%

27

5.3%

13

9.5%

19

6.3%

243

100.0%

6-10 years 34.0% 18.9% 22.6% 0% 24.5% 100.0%

11-15 years 45.5% 45.5% 0% 9.1% 0% 100.0%

16 years + 47.9% 35.6% 13.7% 2.7% 0% 100.0%

Total 42.8% 32.9% 11.1% 5.3% 7.8% 100.0%






Discussion (LS 42):

Majority of participants agree with the statement that the noisy environment

makes communication difficult. The female candidates give highest percentage of

positive responses and difference in positive responses of two genders is significant. The

male participants have given a higher percentage of neutral responses. Female

participants have shown greater percentage of negative responses. Overall the difference

in negative responses of two genders is significant. Table 4.130 shows the statistics

gathered from married and single participants of the research and the results show a

strong agreement of the participants to the statement. A higher percentage of strong

positive responses come from single participants. Highest percentage of neutral responses

is from participants who are married. In negative response to the given statement greater

percentage of response comes from married participants of the research. The difference in

negative, positive and neutral responses of married and single participants is

insignificant. The professional experience shows relationship with positive responses to

164

the statement. In positive responses greater percentage of group 4 of professionals has

shown highest percentage of strong positive response; group 3 participants have shown

highest percentage of moderate positive responses. Highly significant difference in

neutral and negative responses can be seen in table 4.131 however highest percentage of

negative response are recorded from participants of group 1. Professionals of group two

hold highest percentage of neutral responses.

Table 4.132:


(The compatibility of setting (temperature, seating arrangement, surrounding

audience) is a significant factor in communication)

Sex Strongly

Agree


Disagree

Total

Freq

Male

89

32.6%

112

52.5%

30

11.3%

02

1.4%

10

2.1%

243

100%

Female 42.2% 38.2% 13.7% 0% 5.9% 100%

Total 36.6% 46.5% 12.3% 0.8% 3.7% 100.0%





Table 4.133:

Marital status-based variation in the responses to Questionnaire item 43 (The

compatibility of setting (temperature, seating arrangement, surrounding audience)

is a significant factor in communication)

Marital

Status

Strongly

Agree


Disagree

Total

Frequency

Single

89

49.4%

112

44.4%

30

6.2%

02

0%

10

0%

243

100%

Married 30.2% 47.5% 15.4% 1.2% 5.6% 100%

Total 36.6% 46.5% 12.3% 0.8% 3.7% 100.0%


165



7% are married and 0% single. Chi-square shows the difference to be highly significant.

Table 4.134:


(The compatibility of setting (temperature, seating arrangement, surrounding

audience) is a significant factor in communication)

Professional

Experience

Strongly

Agree


Disagree

Total

Frequency

1-5 years

89

52.6%

112

38.9%

30

5.3%

02

0%

10

3.2%

243

100.0%

6-10 years 30.2% 56.6% 13.2% 0% 0% 100.0%

11-15 years 18.2% 45.5% 0% 9.1% 27.3% 100.0%

16 years + 26.0% 49.3% 24.7% 0% 0% 100.0%

Total 36.6% 46.5% 12.3% 0.8% 3.7% 100.0%




group 3. The aggregates of those who disagree have 36 % from group 3, 3% from group,

0% from group 2 and 0 % from group 4. The value of chi-square is significant.

Discussion (LS 43):


compatibility of setting (temperature, seating arrangement, surrounding audience) is a

significant factor in communication. In positive response to the given statement gender

difference, marital status and professional experience of the participants remains

important. In positive response greater percentage of males has shown strongly positive

response while greater percentage of females has shown greater negative responses. The

female participants have showed highest percentage of neutral responses. The difference

is responses of both genders is significant and cannot be ignored. A significant variation

166

of responses can be seen in data gathered from married and single participants. Highest

percentage of positive responses is gathered from single participants however the greater

percentage of negative responses is from married participants. Married participants

compared with singles show more neutral responses. The professional experience of

participants shows an inversely proportional relationship with the statement. Participants

of group 1 show highest percentage of agreement to the statement however greater

negative responses are shown by participants of group 3. Professional experience of the

participants emerged as a significant indicator to test the statement LC-43 and table 4.134

shows variation in responses of different groups of professionals.

Table 4.135:


(Comfortable and relax location promote communication between doctor and

patient)

Sex Strongly

Agree


Disagree

Total

Freq

Male

95

35.5%

103

43.3%

21

12.1%

21

9.2%

03

0%

243

100%

Female 44.1% 41.2% 3.9% 7.8% 2.9% 100%

Total 39.1% 42.4% 8.6% 8.6% 1.2% 100.0%





167

Table 4.136:

Marital status-based variation in the responses to Questionnaire item 44


patient)


Agree


Disagree

Total

Frequency

Single

95

35.8%

103

54.3%

21

6.2%

21

3.7%

03

0%

243

100%

Married 40.7% 36.4% 9.9% 11.1% 1.9% 100%

Total 39.1% 42.4% 8.6% 8.6% 1.2% 100.0%



almost 90 % against that of the married i.e. 77% while among those who disagreed

almost 13% are married and 4% singles. Chi-square shows the difference to be highly

significant.

Table 4.137:



patient)

Professional

Experience

Strongly

Agree


Disagree

Total

Frequency

1-5 years

95

36.8%

103

45.3%

21

5.3%

21

9.5%

03

3.2%

243

100.0%

6-10 years 30.2% 43.4% 3.8% 22.6% 0% 100.0%

11-15 years 54.5% 18.2% 27.3% 0% 0% 100.0%

16 years + 43.8% 45.2% 11.0% 0% 0% 100.0%

Total 39.1% 42.4% 8.6% 8.6% 1.2% 100.0%




168


1, 0% from group 3 and 0 % from group 4. The value of chi-square is significant.

Discussion (LS 44):

Responses of male and female participants to LS 44 shows an agreement to the

statement that comfortable and relax location promote communication between doctor

and patient. Keeping in view sex-based variation of responses, highest percentage of

positive responses comes from the female participants as compared to positive responses

from males likewise in negative responses; percentage of female responses is higher than

males. In neutral responses percentage of male participants is higher than females. In

positive or negative responses to LS 44 (as shown in table 4.135), gender difference

becomes important and the difference in responses is significant. Comparing results

obtained from married and single participants show that majority of single participants

agree with the statement of issue. On the contrary, highest percentage of negative and

neutral responses comes from married participants. Overall difference of responses in

responses of married and single participants is highly significant. Professional experience

turns out to be another important indicator to know about statement given in LC 44.

Highest percentage of positive responses comes from participants having experience of

mere than 16 years experience. Highest percentage of negative responses comes from

people with 6-10 years of professional experience. Group 3 of professionals show highest

percentage of neutral responses.

Table 4.138:


(The level of privacy afford by the setting in which the doctor-patient interaction

occurs also affect doctor-patient communication)

Sex Strongly

Agree


Disagree

Total

Freq

Male

93

40.4%

96

39.0%

36

17.0%

13

3.5%

05

0%

243

100%

Female 35.3% 40.2% 11.8% 7.8% 4.9% 100%

Total 38.3% 39.5% 14.8% 5.3% 2.1% 100.0%


169




Table 4.139:

Marital status -based variation in the responses to Questionnaire item 45 (The level

of privacy afford by the setting in which the doctor-patient interaction occurs also

affect doctor-patient communication)


Agree


Disagree

Total

Frequency

Single

93

46.9%

96

40.7%

36

6.2%

13

3.7%

05

2.5%

243

100%

Married 34.0% 38.9% 19.1% 6.2% 1.9% 100%

Total 38.3% 39.5% 14.8% 5.3% 2.1% 100.0%



almost 88 % against that of the married i.e. 73 % while among those who disagreed

almost 8 % are married and 6 % single. Chi-square shows the difference to be highly

significant.

Table 4.140:


(The level of privacy afford by the setting in which the doctor-patient interaction

occurs also affect doctor-patient communication)

Professional

Experience

Strongly

Agree


Disagree

Total

Frequency

1-5 years

93

41.1%

96

37.9%

36

14.7%

13

3.2%

05

3.2%

243

100.0%

6-10 years 30.2% 34.0% 28.3% 3.8% 3.8% 100.0%

11-15 years 36.4% 27.3% 0% 36.4% 0 % 100.0%

16 years + 41.1% 49.3% 9.6% 0% 0% 100.0%

Total 38.3% 39.5% 14.8% 5.3% 2.1% 100.0%


170




2, 6% from group 1 and 0 % from group 4. The value of chi-square is significant.

Discussion (LS 45):

A highest percentage of participants agree that the level of privacy afford by the

setting in which the doctor-patient interaction occurs also affect doctor-patient medical

discourse. Male participants show highest percentage of positive responses compare with

females. The difference in highly positive and moderately positive responses of both

genders is significant and can be ignored by researcher; greater percentage of negative

responses comes from females while males show higher percentage in neutral responses

to the statement. Difference in responses of both genders is significant. Seeing results of

marital status-based variation, difference in responses of married and single participants

is highly significant. Significantly varied negative and neutral responses can be seen in

table 4.139. The single participants show highest percentage of positive responses while

highest percentage of negative responses comes from the married participants. Married

participants provided greater percentage of neutral responses. In case of professionally

experienced groups, group 4 has shown highest percentage of positive responses.

Professionals of group 3 have shown highest percentage of negative responses while

group 2 appears to be most neutral in response to the statement. Participants having

different professional experience of different years provide significant variation in

results.

171

IX. Time (T46-50)

Table 4.141:


(The doctor’s contact time with patients affect communication)

Sex Strongly

Agree


disagree

Total

Freq

Male

84

36.9%

114

47.5%

32

13.5%

6

2.1%

7

0%

243

100%

Female 31.4% 46.1% 12.7% 2.9% 6.9% 100%

Total 34.6% 46.9% 13.2% 2.5% 2.9% 100.0%





Table 4.142:

Marital status -based variation in the responses to Questionnaire item 46 (The

doctor’s contact time with patients affect communication)

Marital

Status

Strongly

Agree


Disagree

Total

Freq

Single

84

40.7%

114

50.6%

32

2.5%

6

3.7%

7

2.5%

243

100%

Married 31.5% 45.1% 18.5% 1.9% 3.1% 100%

Total 34.6% 46.9% 13.2% 2.5% 2.9% 100.0%





172

Table 4.143:


(The doctor’s contact time with patients affect communication)

Professional

Experience

Strongly

Agree


Disagree

Total

Frequency

1-5 years

84

37.9%

114

56.8%

32

2.1%

6

0%

7

3.2%

243

100.0%

6-10 years 41.5% 39.6% 3.8% 11.3% 3.8% 100.0%

11-15 years 18.2% 54.5% 18.2% 0% 9.1% 100.0%

16 years + 30.1% 37.0% 32.9% 0% 0% 100.0%

Total 34.6% 46.9% 13.2% 2.5% 2.9% 100.0%





3, 3% from group 1and 0% from group 4. The value of chi-square is significant.

Discussion (T 46):


doctor‟s contact time with patients affects communication. On average highest

percentage of positive and neutral response is shown by the male participants as

compared to females. The female participants showed greater percentage of negative

response. However, the difference in neutral, positive and negative response of male and

females is significant. Comparing responses of married and single participants, highest

percentage of positive response is shown by single participants; highest percentage of

neutral response comes from married participants of the research group. Significantly

high percentage of single participants does not agree to the statement. The difference in

responses of married and singles is significant. Interestingly a greater percentage of

professionals with 1-5 years of professional experience show highest percentage of

positive response and agree to the statement T 46. However, participants of group 4 have

shown highest percentage of neutral response. In negative responses to the statement,

173

highest percentage is of group 2 professionals. Once again variation in responses of

professional groups turns out to be a good indicator to test the statement and the results

are significant.

Table 4.144:


(Communicative style of the doctor (whether positive or negative) was not affected

by the length of the interaction)

Sex Strongly

Agree


Disagree

Total

Freq

Male

34

15.6%

68

29.8%

77

27.7%

36

14.9%

28

12.1%

243

100%

Female 11.8% 25.5% 37.3% 14.7% 10.8% 100%

Total 14.0% 28.0% 31.7% 14.8% 11.5% 100.0%




27% are males and 25% females. Value of chi-square is significant.

Table 4.145:




Marital

Status

Strongly

Agree


Disagree

Total

Freq

Single

34

13.6%

68

33.3%

77

28.4%

36

13.6%

28

11.1%

243

100%

Married 14.2% 25.3% 33.3% 15.4% 11.7% 100%

Total 14.0% 28.0% 31.7% 14.8% 11.5% 100.0%




almost 27% are married and 25% single. Chi-square shows the difference to be

insignificant.

174

Table 4.146:




Professional

Experience

Strongly

Agree


Disagree

Total

Frequency

1-5 years

34

11.6%

68

22.1%

77

32.6%

36

21.1%

28

12.6%

243

100.0%

6-10 years 5.7% 34.0% 26.4% 3.8% 30.2% 100.0%

11-15 years 18.2% 18.2% 45.5% 18.2% 0% 100.0%

16 years + 21.9% 34.2% 30.1% 13.7% 0% 100.0%

Total 14.0% 28.0% 31.7% 14.8% 14.0% 100.0%





2, 18% from group 3and 13 % from group 4. The value of chi-square is significant.

Discussion (T 47):

In response to statement that communicative style of the doctors (whether positive

or negative) is not affected by the length of the interaction, the male participants of the

research have shown highest percentage of positive response. Females have provided

higher percentage of moderately and highly negative responses. The difference in

positive responses of both genders is significant. Majority of females remained neutral in

response to the statement. Comparing the results from married and single participants,

greater percentage of strong and moderate responses is shown by the single participants

compared with married participants. Married participants have shown more disagreement

to the statement and the difference in negative responses of single and married

participants appears to be insignificant. Most of married participants remained neutral to

the statement compared with singles. The difference in responses of married and

unmarried people is insignificant and can be ignored. Data gathered from professionals

provides highly significant difference and most varied responses. Group 4 having most

experienced people in the group shows highest percentage of positive responses (Table

175

4.146). The highest percentage of positive responses from most experience people

justifies the statement that communicative style of the doctors (whether positive or

negative) is not affected by the length of the interaction. On comparing neutral responses

of all group highest percentage of neutral responses are shown by group 3. Group 3

professionals with experience of 6-10 years have provided highest percentage of negative

responses. Comparing the neutral and negative percentages of different groups makes the

variation of responses significant.

Table 4.147:


(The length of time available for the consultation affects the nature of the

discussion)

Sex Strongly

Agree


Disagree

Total

Freq

Male

63

28.4%

114

47.5%

41

14.9%

14

5.7%

11

3.5%

243

100%

Female 22.5% 46.1% 19.6% 5.9% 5.9% 100%

Total 25.9% 46.9% 16.9% 5.8% 4.5% 100.0%





Table 4.148:

Marital status -based variation in the responses to Questionnaire item 48(The length

of time available for the consultation affects the nature of the discussion)

Marital

Status

Strongly

Agree


Disagree

Total

Freq

Single

63

27.2%

114

48.1%

41

14.8%

14

6.2%

11

3.7%

243

100%

Married 25.3% 46.3% 17.9% 5.6% 4.9% 100%

Total 25.9% 46.9% 16.9% 5.8% 4.5% 100.0%


176



11 % are married and 10 % single. Chi-square shows the difference to be significant.

Table 4.149:


(The length of time available for the consultation affects the nature of the

discussion)

Professional

Experience

Strongly

Agree


Disagree

Total

Frequency

1-5 years

63

24.2%

114

60.0%

41

7.4%

14

5.3%

11

3.2%

243

100.0%

6-10 years 17.0% 54.7% 11.3% 17.0% 0% 100.0%

11-15 years 18.2% 18.2% 27.3% 0% 36.4% 100.0%

16 years + 37.0% 32.9% 30.1% 0% 0% 100.0%

Total 25.9% 46.9% 16.9% 5.8% 4.5% 100.0%





2, 8% from group 1and 0 % from group 4. The value of chi-square is significant.

Discussion (T 48):

Results demonstrate that the length of time available for the consultation affects

the nature of the discussion. Males show highest percentage of positive responses

compare with females. The difference in highly positive and moderately positive

responses of both genders is significant and cannot be ignored. Greater percentage of

negative responses comes from females while males have less percentage of negative

responses. Both genders show similar percentages in neutral responses to the statement

however female participants scored greater percentage. Difference in neutral, positive and

negative responses of both genders does not show significant difference in responses. On

comparing results of marital based variation, difference in responses of married and

single participants is significant. The single participants show highest percentage of

positive responses while highest percentage of negative responses comes from the

177

married participants. Married participants have shown greater percentage of neutral

responses. In case of professionally experienced groups, group 1 has shown highest

percentage of positive responses. Professionals of group 3 have shown highest percentage

of negative responses while group 4 appears to be most neutral in response to the

statement. Participants having different professional experience of different years provide

significant difference in the responses.

Table 4.150:


(Waiting time for physical examination is long for patients which affect their

communication)

Sex Strongly

Agree


Disagree

Total

Freq

Male

58

23.4%

82

38.3%

50

15.6%

48

21.3%

5

1.4%

243

100%

Female 24.5% 27.5% 27.5% 17.6% 2.9% 100%

Total 23.9% 33.7% 20.6% 19.8% 2.1% 100.0%




23% are males and 21% females. Value of chi-square is insignificant.

Table 4.151:

Marital status -based variation in the responses to Questionnaire item 49(Waiting

time for physical examination is long for patients which affect their communication)

Marital

Status

Strongly

Agree


Disagree

Total

Freq

Single

58

37.0%

82

29.6%

50

25.9%

48

3.7%

5

3.7%

243

100%

Married 17.3% 35.8% 17.9% 27.8% 1.2% 100%

Total 23.9% 33.7% 20.6% 19.8% 2.1% 100.0%


178



29% are married and 7% singles. Chi-square shows the difference to be significant.

Table 4.152:


(Waiting time for physical examination is long for patients which affect their

communication)

Professional

Experience

Strongly

Agree


Disagree

Total

Frequency

1-5 years

58

32.6%

82

25.3%

50

21.1%

48

17.9%

5

3.2%

243

100.0%

6-10 years 11.3% 30.2% 24.5% 34.0% 0% 100.0%

11-15 years 36.4% 54.5% 0% 0% 9.1% 100.0%

16 years + 17.8% 41.1% 23.3% 17.8% 0% 100.0%

Total 23.9% 33.7% 20.6% 19.8% 2.1% 100.0%



belong to professional experience group 3, 59% to group 4, 58% to group 1and 42 % to



Discussion (T 49):

Overall, greater majority of participants agree to the statement that waiting time

for physical examination is long for patients, which affect their communication. In sex-

based responses, greater positive response comes from female participant while highest

percentage of positive responses comes from male participants. In neutral response to the

statement, females have higher percentage compared with males. In positive responses to

statement, gender difference remains unimportant but in neutral and negative responses

significant difference can be observed in table 4.150. The single participants gave a

greater percentage of highly positive response and married participants showed higher

179

percentage of moderate positive response to the statement. A significant difference in

neutral response of singles and married participants is shown in table 4.151 however

single participants of the research show highest percentage of neutral response.

Participants with 11-15 years of professional experience show highest percentage of

positive response while people of group 2 show highest percentage of negative

percentage. The greater percentage of neutral responses is shown by participants

belonging to group 2 of professionals. Difference in responses of different group is

significant.

Table 4.153:


(Doctors get enough time for each individual patient as far as examination is

concerned)

Sex Strongly

Agree


Disagree

Total

Freq

Male

60

28.4%

66

24.1%

23

6.4%

52

18.4%

42

22.7%

243

100%

Female 19.6% 31.4% 13.7% 25.5% 9.8% 100%

Total 24.7% 27.2% 9.5% 21.4% 17.3% 100.0%



almost 53 % against that of the females i.e. 50% while among those who disagreed

almost 41% are males and 35% females. Value of chi-square is significant.

Table 4.154:


get enough time for each individual patient as far as examination is concerned)

Marital

Status

Strongly

Agree


Disagree

Total

Freq

Single

60

21.0%

66

35.8%

23

9.9%

52

19.8%

42

13.6%

243

100%

Married 26.5% 22.8% 9.3% 22.2% 19.1% 100%

Total 24.7% 27.2% 9.5% 21.4% 17.3% 100.0%


180




Table 4.155:


(Doctors get enough time for each individual patient as far as examination is

concerned)

Professional

Experience

Strongly

Agree


Disagree

Total

Frequency

1-5 years

60

25.3%

66

17.9%

23

8.4%

52

28.4%

42

20.0%

243

100.0%

6-10 years 39.6% 28.3% 15.1% 5.7% 11.3% 100.0%

11-15 years 0% 63.6% 0% 36.4% 0% 100.0%

16 years + 20.5% 27.4% 9.6% 19.2% 23.3% 100.0%

Total 24.7% 27.2% 9.5% 21.4% 17.3% 100.0%






Discussion (T 50):

Majority of male participants show an agreement to the statement that doctors get

enough time for each individual patient as far as examination is concerned however

majority of females remained neutral to the statement. The male participants of the

project provide highest percentage of positive and negative responses. The difference in

responses of both genders is significant and cannot be ignored. Single participants agree

with the statement in majority. The percentage difference of neutral responses is

insignificant. In neutral response to the given statement gender difference remains

unimportant however in positive response greater percentage of singles has shown

positive response similarly greater percentage of married participants have shown greater

percentage of negative responses. Like genders and marital status, the professional

181

experience has emerged as a significant indicator to test T50. The percentage of neutral

responses is highly significant across different groups of professionals. In positive

response greater percentage of group 2 professionals has shown strongly positive

response while group 3 professionals have shown greater percentage of moderately

positive responses. The group 2 professionals show highest percentage of neutral and

group 1 has given highest percentage of negative responses. The differences in neutral

and negative responses of different group appear to be significant.

X Education (ED 51-55)

Table 4.156:


(The level of education of patient is prominent factor in effective communication)

Sex Strongly

Agree


Disagree

Total

Freq

Male

90

39.7%

102

41.1%

22

7.1%

13

2.8%

16

9.2%

243

100%

Female 33.3% 43.1% 11.8% 8.8% 2.9% 100%

Total 37.0% 42.0% 9.1% 5.3% 6.6% 100.0%



almost 81 % against that of the females i.e. 76% while among those who disagreed

almost 13% are females and 12% males. Value of chi-square is significant.

Table 4.157:

Marital status -based variation in the responses to Questionnaire item 51 (The level

of education of patient is prominent factor in effective communication)


Agree


Disagree

Total

Frequency

Single

80

43.2%

108

50.6%

42

0%

11

6.2%

2

0%

243

100%

Married 34.0% 37.7% 13.6% 4.9% 9.9% 100%

Total 32.9% 44.4% 17.3% 4.5% 0.8% 100.0%


182




Table 4.158:


(The level of education of patient is prominent factor in effective communication)

Professional

Experience

Strongly

Agree


Disagree

Total

Frequency

1-5 Years

90

33.7%

102

51.6%

22

0%

13

8.4%

16

6.3%

243

100.0%

6-10 Years 37.7% 35.8% 7.5% 0% 18.9% 100.0%

11-15 Years 36.4% 36.4% 27.3% 0% 0% 100.0%

16 Years + 41.1% 35.6% 16.4% 6.8% 0% 100.0%

Total 37.0% 42.0% 9.1% 5.3% 6.6% 100.0%





1, 7% from group 4, and 0% from group 3. The value of chi-square is significant.

Discussion (ED 51):

It can be seen from table no 4.156-4.158 that majority of the participants agree to

the statement, “The level of education of patient is prominent factor in effective

communication”. In positive response, greater percentage of males has shown strongly

positive response while greater percentage of females has shown greater negative and

moderately negative responses. The female participants have showed highest percentage

of neutral responses. The difference is responses of both genders is significant and cannot

be ignored. A significant variation of responses can be seen in data gathered from

married and single participants. Highest percentage of positive responses is gathered from

single participants while married participants have shown highest percentage of negative

responses. In neutral responses married participants have greater percentage compared

183

with singles. In negative and positive responses two groups show significant difference.

Participants of group 1 show highest percentage of agreement to the statement however

greater negative responses are shown by participants of group 2. Professional experience

of the participants emerged as a highly significant indicator to test the statement T 51and

table 4.158 shows variation in responses of different groups of professionals.

Table 4.159:


(Low health literacy of the patient affects communication)

Sex Strongly

Agree


Disagree

Total

Freq

Male

80

34.0%

108

46.1%

42

16.3%

11

2.8%

2

0.7%

243

100%

Female 31.4% 42.2% 18.6% 6.9% 1.0% 100%

Total 32.9% 44.4% 17.3% 4.5% 0.8% 100.0%


The aggregate percentages of the males who agreed with the statement are almost

80% against that of the females i.e. 74 % while among those who disagreed almost 8 %

are females and 4 % males. Value of chi-square is significant.

Table 4.160:

Marital status-based variation in the responses to Questionnaire item 52 (Low

health literacy of the patient affects communication)


Agree


Disagree

Total

Frequency

Single

80

46.9%

108

37.0%

42

13.6%

11

0%

2

2.5%

243

100%

Married 25.9% 48.1% 19.1% 6.8% 0% 100%

Total 32.9% 44.4% 17.3% 4.5% 0.8% 100.0%


The aggregate percentages of the singles who agreed with the statement is almost

84 % against that of the married i.e. 74% while among those who disagreed almost 7%

are married and 3% single. Chi-square shows the difference to be significant.

184

Table 4.161:


(Low health literacy of the patient affects communication)

Professional

Experience

Strongly

Agree


Disagree

Total

Frequency

1-5 Years

80

33.7%

108

49.5%

42

11.6%

11

3.2%

2

2.1%

243

100.0%

6-10 Years 43.4% 39.6% 17.0% 0% 0% 100.0%

11-15 Years 36.4% 36.4% 0% 27.3% 0% 100.0%

16 Years + 23.3% 43.8% 30.1% 2.7% 0% 100.0%

Total 32.9% 44.4% 17.3% 4.5% 0.8% 100.0%





1, 3% from group 4, and 0% from group 2. The value of chi-square is significant.

Discussion (ED 52):

Results demonstrate a strong agreement of participants to the statement that low

health literacy of the patient affects communication. In sex-based responses, greater

majority of males provided positive responses compared with females. Females give

highest percentage of negative and moderately negative response similarly greater

percentage of females has shown neutral responses. The difference in responses of males

and female participants is significant. Comparing response of married and single people,

highest percentage of strong positive responses comes from single participants while

married participants have highest ratio of moderately positive response. A significant

difference in negative responses of married and single participants can be seen in table

4.160 where the married participants of the research show highest percentage of negative

response. The percentage of neutral responses is significant and married people show a

greater percentage of neutral responses. Like previous discussion, professional

experience of participants emerged as a clear indicator for the study of statement ED 52.

The percentage of neutral responses given by groups show highly significant variation;

however group 4 professionals have shown highest percentage of neutral response. Group

2 participants have highest ration of strong positive responses where as group 1

professional have shown highest percentage of moderately positive response. The

185

percentage of negative responses is highly significant and cannot be ignored. Group to

have highest percentage of negative response is group 3.

Table 4.162:


(Doctors feel uncomfortable while communicating with a patient whose

intellectual level is lower)

Sex Strongly

Agree


Disagree

Total

Freq

Male

48

24.1%

96

41.8%

33

9.9%

51

21.3%

15

2.8%

243

100%

Female 13.7% 36.3% 18.6% 20.6% 10.8% 100%

Total 19.8% 39.5% 13.6% 21.0% 6.2% 100.0%





Table 4.163:

Marital status-based variation in the responses to Questionnaire item 53 (Doctors

feel uncomfortable while communicating with a patient whose intellectual level is

lower)


Agree


Disagree

Total

Frequency

Single

48

23.5%

96

44.4%

33

9.9%

51

16.0%

15

6.2%

243

100%

Married 17.9% 37.0% 15.4% 23.5% 6.2% 100%

Total 19.8% 39.5% 13.6% 21.0% 6.2% 100.0%


The aggregate of the percentages of the single that agreed with the statement is



186

Table 4.164:


(Doctors feel uncomfortable while communicating with a patient whose

intellectual level is lower)

Professional

Experience

Strongly

Agree


Disagree

Total

Frequency

1-5 Years

48

20.0%

6

45.3%

33

8.4%

51

20.0%

15

6.3%

243

100.0%

6-10 Years 30.2% 18.9% 15.1% 30.2% 5.7% 100.0%

11-15 Years 18.2% 27.3% 27.3% 0% 27.3% 100.0%

16 Years + 12.3% 50.7% 15.1% 21.9% 0% 100.0%

Total 19.8% 39.5% 13.6% 21.0% 6.2% 100.0%



belong to professional experience group 1, 63% to group 4, 49 % to group 2 and 46 % to



Discussion (ED 53):

A highest percentage of participants agree that doctors feel uncomfortable while

communicating with a patient whose intellectual level is lower. Male participants show

highest percentage of positive responses compare with females. The difference in highly

positive and moderately positive responses of both genders is significant and cannot be

ignored by researcher. Greater percentage of negative responses comes from females

while males have less percentage of negative responses. Females show higher

percentages in neutral responses to the statement. Difference in responses of both genders

is significant. Comparing results on marital status-based variation, difference in responses

of married and single participants is significant. Significantly varied negative and neutral

responses can be seen in table 4.163. The single participants show highest percentage of

positive responses while highest percentage of negative responses comes from the

married participants. Married participants provided greater percentage of neutral

187

responses. In case of professionally experienced groups, group 1 has shown highest

percentage of positive responses. Professionals of group 2 have shown highest percentage

of negative responses while group 3 appears to be most neutral in response to the

statement. Participants having different professional experience of different years provide

significantly varied results.

Table 4.165:


(Patients' ability to explain their conditions (complaints and symptoms) to the

doctor is a factor that also impacts the quality of doctor-patient communication)

Sex Strongly

Agree


Disagree

Total

Freq

Male

67

33.3%

118

47.5%

50

17.0%

8

2.1%

0

0%

243

100%

Female 19.6% 50.0% 25.5% 4.9% 0% 100%

Total 27.6% 48.6% 20.6% 3.3% 0% 100.0%





Table 4.166:

Marital status-based variation in the responses to Questionnaire item 54 (Patients'

ability to explain their conditions (complaints and symptoms) to the doctor is a

factor that also impacts the quality of doctor-patient communication)


Agree


Disagree

Total

Frequency

Single

67

22.2%

118

55.6%

50

12.3%

8

9.9%

0

0%

243

100%

Married 30.2% 45.1% 24.7% 0% 0% 100%

Total 27.6% 48.6% 20.6% 3.3% 0% 100.0%


188


almost 78 % against that of the married i.e. 75 % while among those who disagreed


Table 4.167:


(Patients' ability to explain their conditions (complaints and symptoms) to the

doctor is a factor that also impacts the quality of doctor-patient communication)

Professional

Experience

Strongly

Agree


Disagree

Total

Frequency

1-5 years

67

24.2%

118

53.7%

50

16.8%

8

5.3%

0

0%

243

100.0%

6-10 years 13.2% 37.7% 43.4% 5.7% 0% 100.0%

11-15 years 18.2% 54.5% 27.3% 0% 0% 100.0%

16 years + 45.2% 47.9% 6.8% 0% 0% 100.0%

Total 27.6% 48.6% 20.6% 3.3% 0% 100.0%



belong to professional experience group 4, 78% to group 1, 73 % to group 3 and 51% to

group 2. The aggregates of those who disagree have 6 % from group 2, 5% from group 1,

0% from group 4 and 0% from group 3. The value of chi-square is significant.

Discussion (ED 54):

In positive responses to statement that patients' ability to explain their conditions

(complaints and symptoms) to the doctor is a factor that also impacts the quality of

doctor-patient medical discourse, highly positive responses are collected from the male

participants compared with females. There is a significant difference in positive

responses gathered from male and female participants however the female participants

show highest percentage of negative responses. A great percentage of females remained

neutral in response to the statement. In positive responses, both married and single

participants show almost equal percentages of agreement with the statement. Single

189

participants have shown higher percentage of negative responses than singles. A

significant difference can be seen in the neutral response to the statement where singles

have lower percentage of neutral response compared to married participants. Participant

with more than 16 years of professional experience (group 4) show highest percentage of

positive responses while highest percentage of negative responses comes from group 2.

Professionals of group 2 showed maximum percentage of neutral responses. Overall,

professional experience of participants provides significant results and professional

experience works as a good indicator to test statement.

Table 4.168:


(Doctors should try to communicate at the hearer’s level of conceptualization to

ensure understanding by the patient)

Sex Strongly

Agree


Disagree

Total

Frequency

Male

62

26.2%

133

53.9%

26

9.2%

12

5.0%

10

5.7%

243

100%

Female 24.5% 55.9% 12.7% 4.9% 2.0% 100%

Total 25.5% 54.7% 10.7% 4.9% 4.1% 100.0%





Table 4.169:

Marital status-based variation in the responses to Questionnaire item 55 (Doctors

should try to communicate at the hearer’s level of conceptualization to ensure

understanding by the patient)


Agree


Disagree

Total

Frequency

Single

62

30.9%

133

61.7%

26

3.7%

12

3.7%

10

0%

243

100%

Married 22.8% 51.2% 14.2% 5.6% 6.2% 100%

Total 25.5% 54.7% 10.7% 4.9% 4.1% 100.0%


190



almost 12 % are married and 4% single. Chi-square shows the difference to be

significant.

Table 4.170:


(Doctors should try to communicate at the hearer’s level of conceptualization to

ensure understanding by the patient)

Professional

Experience

Strongly

Agree


Disagree

Total

Frequency

1-5 Years

62

21.1%

133

63.2%

26

3.2%

12

12.6%

10

0%

243

100.0%

6-10 Years 47.2% 52.8% 0% 0% 0% 100.0%

11-15 Years 18.2% 45.5% 36.4% 0% 0% 100.0%

16 Years + 17.8% 47.9% 20.5% 0% 13.7% 100.0%

Total 25.5% 54.7% 10.7% 4.9% 4.1% 100.0%



belong to professional experience group 2, 84% to group 1, 66 % to group 4 and 64 % to

group 3. The aggregates of those who disagree are 14% from group 4, 13% from group 1,

0% from group 2and 0% from group 3. The value of chi-square is significant.

Discussion (ED 55):

A great majority of participants agree with the statement doctors should try to

communicate at the hearer‟s level of conceptualization to ensure understanding by the

patient. In sex-based variation, the males and females show equal percentage of positive

responses but the difference in positive responses of both genders is insignificant and can

be ignored. Greater percentage of highly negative or moderately negative response comes

from the male participants while the female participants of the research give more neutral

191

responses. Gender difference cannot be a good indicator to test statement. In marital

status-based data collection, highest positive responses come from single participants

while highest percentage of negative responses comes from married participants. Married

participants have shown the highest percentage of neutral responses. The difference in

negative responses of singles and married participants turn out to be significant. Highly

significant difference can be seen in responses of participants have different duration of

professional experiences. Group 2 experienced participants having experience of 6-10

years show maximum percentage of positive responses. The participants having

experience of more than 16 years show highest percentage of negative responses. The

group 3 of professionals shows highest percentage of neutral responses. The difference in

responses of participants belonging to different groups of professional experience

provides a significant variation of responses.

4.2.2 Construct Wise Analysis

The analysis here depicts trends of data collectively for one whole construct

distinctive from single item analysis. It has been done to have a convenient over view of

the linguistic and social factors which creates miscommunication between doctor and

patient at government hospitals of district Rawalpindi. It also help to know tendencies of

the participants on each construct for a comparative glance. For the sake of analysis,

mean and standard deviation of each item have been calculated to know their intensity as

well as frequency.

192

I. Language Factor (LF)

Table 4.171:

From LF1- to LF10

Items N Mean Std. Deviation

LF1 243 1.3416 .74037

LF2 243 2.1440 1.06786

LF3 243 1.5926 .75697

LF4 243 1.9342 .99367

LF5 243 1.8272 .79446

LF6 243 1.9342 1.11145

LF7 243 1.8560 1.09461

LF8 243 1.9877 .98954

LF9 243 2.2963 1.00138

LF10 243 2.3621 1.08736

The above table shows that participants agreed on all items of language factor.

The values of mean and standard deviation also verified their strong agreement for above

factor. LF10 which states that non-verbal expressions also contribute to effective

communication has highest positive responses whereas LF1 which states that the

language is predominant instrument by which information can be transmitted has lowest

positive response.

193

II. Doctor’s Training in Communication Skills (DT)

Table 4.172:

From DT11- to DT17


DT11 243 2.0741 1.11093

DT12 243 1.9053 1.02212

DT13 243 1.9012 .85674

DT14 243 2.4239 1.07053

DT15 243 2.2016 .92959

DT16 243 2.0412 .93947

DT17 243 2.5391 1.11411

The above table shows that participants agreed on all items of Doctor‟s training in

communication skills. The values of mean and standard deviation also verified their

strong agreement for above factor. DT17 which states that provision of closure in

interaction is due to communication training has highest positive responses whereas DT13

which states that successful medical encounters require effective communication skills between

the patient and the doctor has lowest positive response.

194

III. Speaking Proficiency (SP)

Table 4.173:

From SP18- to SP22


SP18 243 1.8724 .87916

SP19 243 2.2840 1.01925

SP20 243 2.4856 1.00556

SP21 243 1.9835 .87181

SP22 243 2.2593 1.11093

The above table shows that participants agreed on all items of speaking

proficiency. The values of mean and standard deviation also verified their strong

agreement for above factor. SP20 which states that patients often have trouble in

understanding doctors because he/she speaks too fast has highest positive responses whereas

SP18 which states that the spoken language is the most important tool of

communication in m e d i c i n e has lowest positive response.

IV. Listening Comprehension (LC)

Table 4.174:

From LC23- to LC24


LC23 243 1.7695 .96871

LC24 243 2.0370 .95057

LC25 243 2.2058 1.10542

LC26 243 2.0082 .91359

The above table shows that participants agreed on all items of listening

comprehension. The values of mean and standard deviation also verified their strong

195

agreement for above factor. LC25 which states that preoccupations such as eating,

drinking or doing handiwork divide attention which mars the listening has highest

positive responses whereas LC23 which states that the l istening attentively creates a

partnership between doctor and patient has lowest positive response.

V. Jargon/Medical Terminology (JT)

Table 4.175:

From JT27 to JT30


JT27 243 2.3457 1.13721

JT28 243 2.0247 .89501

JT29 243 2.4115 1.12236

JT30 243 2.2222 1.09091

The above table shows that participants agreed on all items of jargon/medical

terminology. The values of mean and standard deviation also verified their strong

agreement for above factor. JT29, which states that jargon acts as harmful indicator for

medical treatment of a patient has highest positive responses whereas JT28 which states

that the p atients often fail to understand the meaning of jargon has lowest positive

response.

Discussion:

Above five linguistic factors present a very favorable picture that all these factors are

creating a miscommunication as stated by respondent i-e doctors. They considered it very

significant factors. Among them are SP 20 i-e patients often have trouble in understanding

doctors because he/she speaks too fast and JT 29 which states that jargon acts as harmful

indicator for medical treatment of a patient. It is fact and common observation also that

SP20 and JT29 are frequently considered as major barrier between doctor and patient

communication.

196

VI. Gender (G)

Table 4.176:

From G31 to G35


G31 243 2.4074 1.12571

G32 243 3.0165 1.38160

G33 243 2.6461 1.13830

G34 243 2.5473 1.24018

G35 243 3.2346 1.26561

The above table shows that participants agreed on G31, G33, and G34 of gender.

The values of mean and standard deviation also verified their agreement for above factor.

But on G32 and G35 respondents were indecisive. G32 states that female doctors are

more caring and facilitate more dialogue between the patient and the doctor while G35

indicates that male doctors spend more time in interviewing female patients than male

patients.

VII. Personality (P)

Table 4.177:

From G36 to G41


P36 243 2.8148 1.28350

P37 243 2.1481 1.29950

P38 243 2.7243 1.26054

P39 243 2.2305 1.01455

P40 243 1.7613 .93631

P41 243 1.7325 .89446

197

The above table shows that participants agreed on all items of personality. The

values of mean and standard deviation also verified their strong agreement for above

factor. P36 which states that doctors don't communicate well due to their personality has

highest positive responses whereas P41 which states that the d octors encourage patients

to ask questions has lowest positive response.

VIII. Location and Setting (LS)

Table 4.178:

From LS42 to LS45


LS42 243 2.0247 1.20921

LS43 243 1.8848 .91988

LS44 243 1.9053 .96386

LS45 243 1.9342 .96412

The above table shows that participants agreed on all items of location and

setting. The values of mean and standard deviation also verified their strong agreement

for above factor. LS42 which states that the noisy environment makes communication

difficult has highest positive responses whereas LS43 which states that the compatibility

of setting (temperature, seating arrangement, surrounding audience) is a significant factor

in communication has lowest positive response.

IX. Time (T)

Table 4.179:

From T46 to T50


T46 243 1.9218 .91253

T47 243 2.8189 1.19232

T48 243 2.1605 1.02195

T49 243 2.4239 1.11589

T50 243 2.7942 1.45981

The above table shows that participants agreed on all items of time. The values of

mean and standard deviation also verified their strong agreement for above factor. T47

which state that the communicative style of the doctor (whether positive or negative) was

not affected by the length of the interaction has highest positive responses whereas T46

198

which states that the doctor‟s contact time with patients affect communication has lowest

positive response.

X. Education (ED)

Table 4.180:

From ED51 to ED55


ED51 243 2.0247 1.12788

ED52 243 1.9588 .87099

ED53 243 2.5432 1.19968

ED54 243 1.9959 .78466

ED55 243 2.0741 .96352

The above table shows that participants agreed on all items of education. The

values of mean and standard deviation also verified their strong agreement for above

factor. ED53 which states that the doctors feel uncomfortable while communicating

with a patient whose intellectual level is lower has highest positive responses whereas

ED54 which states that the patients' ability to explain their conditions (complaints and

symptoms) to the doctor is a factor that also impacts the quality of doctor-patient

communication has lowest positive response.

Discussion:

Above five social factors present a very clear picture that all these factors are

creating a miscommunication as stated by respondents i-e doctors. They considered it

very significant factors. Among them are T47 i-e communicative style of the doctor

(whether positive or negative) was not affected by the length of the interaction and P36

which states that doctors don't communicate well due to their personality. It is fact and

common observation also that T47 and P36 are frequently considered as major barrier

between doctor and patient communication.

199

4.2.3 Descriptive Statistics

Table No 4.181 (Linguistic Factors)

Factors N Minimum Maximum Mean Median Mode

LF 243 1.00 4.50 1.9276 1.7873 1.70

DT 243 1.00 4.86 2.1552 2.0549 2.14

SP 243 1.00 4.80 2.1770 2.1500 2.00

LC 243 1.00 4.00 2.0051 1.9462 2.00

JMT 243 1.00 4.50 2.2510 2.1233 2.00

Discussion:

Descriptive statistics are used to measure the performance of the participants on

the questionnaire in the numerical terms (Brown, 1996). They show the average values

for the performance of each participant on all the items aimed for a particular measure.

The labels in the table above represent each measure as follows. LF represents Language

factor, DT is the Doctor‟s training in communication skills, SP is speaking proficiency,

LC is Listening comprehension, and JMT is Jargon or Medical terminology.

In descriptive statistics the central tendency of scores is indicated by the mean,

mode and median. On the other hand, minimum and maximum values are used to indicate

the extent to which the scores are dispersed around the mean. The extent of this

dispersion is proportionate to the diversity in the responses made by the participants.

Highest mean which is of JMT i-e Jargon and Medical Terminology indicates that

patients are facing a lot of problems in understanding as well as treatment of their

respective diseases. Language factor is considered to be the lowest as indicated by the

value of mean. This factor is creating less miscommunication.

200

Table No 4.182 (Social Factors)

Factors N Minimum Maximum Mean Median Mode

G 243 1.00 4.60 2.7704 2.8231 3.00

P 243 1.00 4.40 2.2362 2.1600 2.00

LS 243 1.00 4.75 1.9372 1.8086 1.00

T 243 1.00 4.20 2.4239 2.4080 2.60

ED 243 1.00 3.80 2.1193 2.0576 1.60

Discussion:

Descriptive statistics are used to measure the performance of the participants on

the questionnaire in the numerical terms (Brown, 1996). They show the average values

for the performance of each participant on all the items aimed for a particular measure.

The labels in the table above represent each measure as follows. G represents Gender, P

is the Doctor‟s personality, LS is Location and setting, T is time, and E is Education.

In descriptive statistics the central tendency of scores is indicated by the mean,

mode and median. On the other hand, minimum and maximum values are used to indicate

the extent to which the scores are dispersed around the mean. The extent of this

dispersion is proportionate to the diversity in the responses made by the participants.

Highest mean which is of G i-e Gender indicates that patients are facing a lot of problems

due to doctor‟s personality. Location and setting is considered to be the lowest as

indicated by the value of mean. This factor is creating less miscommunication.

4.3. Analysis of Open-Ended Part Responded by Doctors

Two open-ended items were used in this study. Here the participants were

provided a relatively free choice to express their feelings and perception related to the

issue. The categories were developed on the basis of grouping tendency among the

responses on thematic similarity and then qualitative analyses were made on simple

percentages to understand significant trends in the data.

201

4.3.1. Demographics

Table No: 4.183 Demographic information of open-ended data

Q1 Q2

Valid

N=243

Missing

190

53

187

56

The table shows in total 243 participants responded to the open-ended items. Out

of them 190 responded to item no 1 while 53 did not, 187 responded to item no 2 while

56 did not responded. The reason for this lack of response by approximately 25% of the

participants is that they took it as an extra burden. Moreover, the doctors have hectic

daily schedule and have other family commitments to manage so it is difficult for them to

respond in writing. They have to examine almost two hundred patients every day. But it

can still be considered a good turnout keeping all such negative factors in mind.

Q1. What do you think could be done to improve doctor-patient medical discourse?

Table No 4.184

Presentation of data from open-ended question 1

Sr.

No

Suggestions to improve doctor-patient

communication

Frequency Percentage

1. Maximum time should be given to patients 138 72%

2. Workshops/seminar to be conducted on

communication skills

125 66%

3. Doctors should listen attentively to patients 100 53%

4. Training on communication skills for doctors

during studies

95 50%

5 Health literacy to be improved among patients 90 47%

6. Doctors‟ behavior and attitude with patients to be

improved

85 45%

202

7. Improvement in setting and location of

examination room

73 38%

8. Privacy of patient‟s consultation to be maintained 70 37%

9. Language barriers to be overcome 65 34%

10. Doctor – patient ratio to be decreased 63 33%

11. Counseling and educating of patients towards

treatment

60 32%

12. Conducive environment for consultation of

patients

58 31%

13. Provision of medical equipments and free

medicine to patients

55 29%

14. Patients‟ complaint to be addressed 52 27%

15.

16.

17.

Medical terminology/jargon to be used at

minimum

New hospitals and clinics to be opened

Seating arrangement in waiting area for patients

to be improved

42

13

02

22%

07%

01%

The above table indicates suggestions given by doctors which can improve doctor-patient

communication.

Thematic Categories:

The answers in this case have been divided into seventeen different categories on the

basis of variety of themes identified. These categories are briefly explained below:

1. Time: it means the duration of consultation between doctors and patients; if

increased, can the factor of duration may strengthen doctor-patient relationship. The

frequency of this theme is 138 and thus has the highest value among all the categories;

therefore, the factor of time stands to be the most effective and important in comparison

to all the other factors.

2. Workshops/seminars: it was suggested that workshops and seminars on

communication skills must be arranged for doctors on regular basis, since

203

workshops/seminars improve doctors‟ relationship with patients. This theme has the

second highest frequency among the categories developed. Its percentage is 66%.

3. Listening: it indicates that doctors should listen attentively to patients as it is the

main factor which creates miscommunication during their consultation with patients.

Listening, on the basis of its frequency, stands as the third most frequent category. Its

frequency value is 100.

4. Training: this category implies that doctors should undergo a training course in

communication skills which may help them to handle patients effectively. Its percentage

is 50%.

5. Health literacy: this category implies a need to educate patients in health

literacy. It is a very important factor whose absence sometimes becomes harmful during

patient‟s treatment. It stands as the fifth most frequent theme as its frequency value is 90.

6. Attitude: this category implies that attitude and behavior of doctors must be

changed towards patients. The prevailing situation demands that doctors should be polite,

kind and sympathetic towards their patients. Its percentage is 45%.

7. Setting and location: this category implies that patients should be provided a

comfortable/relaxing setting/location during consultation. It has to be noted that hidden

between the lines in this category is a reaction against government hospitals. It is the

most important issue that was pointed and observed by the doctors. Its frequency value is

73.

8. Privacy: the respondents in this category believe that maintaining privacy during

doctor- patient interaction is mandatory. Its percentage is 37%.

9. Language barriers: this category means that barriers of language should be

overcome for smooth and uninterrupted consultation. Its frequency value is 65.

10. Doctor-patient ratio: the answers in this category suggest decreasing doctor –

patient ratio. Doctors are supposed to examine almost 200 patients a day. It is a very

high ratio. The ratio factor has got its own significance. Its percentage is 33%. .

11. Counseling: this is again a suggestion to educate patients on medical treatment

plan. It helps patients to understand and know about their disease and its precautionary

measures. Its frequency value is 60.

204

12. Conducive environment: it is one of the requirements suggested by doctors to

have a conducive environment for effective communication. Its percentage is 31%.

13. Provision of medical equipments: this is a suggestion which emphasizes the

need to provide medical equipment to hospitals and free medical care for patients. It

facilitates poor patients. Its frequency value is 55

14. Patients’ complaint: it is one of the requirements suggested by doctors to address

patients‟ complaints. Its percentage is 27%.

15. Medical terminology/jargon: this is a suggestion being made in order to avoid

using medical terminology /jargon while talking to patients. It facilitates uneducated

patients. Its frequency value is 42.

16. New hospitals and clinics to be opened: it is also recommended that new

hospitals and private clinics be opened so that patients have more options of treatment. Its

percentage is 7%.

17. Seating arrangements: this is also a suggestion that seating arrangements in

waiting area for patients should be improved. Its frequency value is 2.

Discussion

The question designed for this study aimed to ask suggestions and measures

which can improve relationship between doctor and patient. The categories induced from

the answers are not all related precisely to the question. However, they provide

significant information about the topic of research, so they have been considered for the

analysis. It is important to note that there are many categories which are common among

all respondents. It is because the respondents give them a lot of importance as key

factors. Open-ended items seem to have provided a chance to the respondents to express

their views freely which would have never found a chance in close-ended items where the

choice is restricted to the range provided by the researcher. There are fifteen factors

which have their frequency in double figure and only two have their percentage in figures

less than ten. It can be found that a remarkably higher number of the respondents give

suggestions and recommendations to improve doctor-patient relationship.

Time is the most important factor which may help reduce miscommunication. At

present doctors give less time to patients as they are bound to check up almost two

205

hundred patients a day. So it is not practically possible for doctors in government

hospitals to give proper time to each individual patient. This aspect means more doctors

should be appointed to reduce doctor-patient ratio.

Workshops and seminars should be arranged for newly appointed doctors to improve

their communication skills, taking advantage from the experience of senior doctors.

Training in communication skills may be given during the trainee doctors‟ studies.

Attitude of doctors is another factor which may influence relationship between doctors

and patients. Doctors should be polite, kind, and sympathetic towards patients. They

should listen attentively and try to understand their patients‟ problems. Considering

patients‟ problems is an important factor which helps doctors to get maximum

information from patients. It helps in treating patient more effectively. Doctors must

educate patients on health literacy. In our society, this problem exists in all dimensions.

Patients are suffering from the harmful effects of being uneducated. Community should

be given awareness about health literacy through mass media like radio, television, press

and the internet.

Language barriers can also be removed by educating patients. Basic knowledge of

medical should be given to patients so that they can use medicine correctly and timely.

Counseling of patient is one of the foremost duties of doctors. They can tell all pros and

cons of medicine and medical treatment to patients. Precautions should be informed in

advance about medicine. Patients‟ complaints should be addressed timely and prompt

action can be taken to improve doctor-patient medical discourse. Use of medical

terminology or jargon should be avoided or at least if not be minimized.

Privacy is another factor which undoubtedly improves doctor-patient relationship

to its maximum. Privacy can only be maintained if setting or location supports it. It has

been observed that patients are bound to consult while disclosing private or sensitive

information in the presence of other patients. This frequently leads to an incomplete

diagnosis of a patient. A proper seating arrangement in waiting area is essential for all

patients. Due to an ever increasing population, it is necessary to open new hospitals and

clinics in various tehsils of district Rawalpindi.

206

There are some other suggestions which cannot be given much importance in view of

their frequency being so low as to render them insignificant. The discussion here

furnishes answer to research questions number 3, 4 and 5 above.

Q2. What do you think could be done to reduce miscommunication between doctor-

patient?

Table No 4.185:

Presentation of data from open-ended question 2

Sr.

No

Suggestions to improve doctor-patient

communication

Frequency Percentage

1. Listening to patients by doctors 146 78%

2. Training program on communication skills for

doctors

135 72%

3. Facility of translators or interpreters in hospitals 119 64%

4. Reducing workload of doctors 94 50%

5 Role of relative or attendant 84 45%

6. Consultation time should be increased 72 38%

7. Suggestion box in hospitals 63 34%

8. Continuous monitoring of hospitals by EDO

health

58 31%

9. Greater interaction with patients 45 24%

10. Patient education on health literacy 37 20%

11. Female patients to be provided female doctors 32 17%

12. Medical terminology/jargon to be used at

minimum

30 16%

13. Four skills of language to be taught during MBBS

degree program

28 15%

14. Doctors of local area should be appointed or

posted

21 11%

207

15. Charts and visuals to be used during consultation

with patients

18 09%

16. Salary of doctors to be increased 16 08%

The above table indicates suggestions, given by doctors, which can reduce

miscommunication between doctor and patient.

Thematic Categories:

The answers in this case have been divided into sixteen different categories on the basis

of variety of themes identified. These categories have been briefly explained below;

1. Listening; it indicates that doctors should be good listeners. Patients sometimes speak

in low voice. Thanks to their accent and/or dialect, some patients also create

miscommunication while talking to doctors. This theme has the highest frequency and

hence stands to be the most important reason for miscommunication between doctor and

patient. Its percentage is 78%.

2. Training: this category implies that doctors should undergo a training course in

Communication skills which help them handle patients effectively. It has the second

highest percentage, proving it to be the second most important theme in the list. The

percentage of those who feel that training in communication skills is mandatory for

doctors is 72%.

3. Translator /interpreter: it was suggested that the provision of translator or

interpreter is essential for both doctor and patient. This facility overcomes language

barriers and thus miscommunication. This is the third most important category for having

the third highest frequency. It has a highly significant frequency value i.e. 119

4. Workload of doctors: the answers in this category suggest decreasing workload of

doctors. Doctors are bound to check up almost 200 patients on daily basis which is a

very high ratio. This is the fourth most frequent theme with its percentage being 50; its


5. Relative and attendant of patient: this category shows the role of relative or

attendant of patient in doctor-patient medical discourse. It is a very important factor

which always facilitates doctors in understanding a patient for medical treatment. It is

among the five most frequent themes as its frequency value is 84.

208

6. Time: it implies the length of time which is to be increased for the consultation of

patients by doctors. The time factor helps in a better diagnosis of disease and further

medical treatment. Its percentage is 38%.

7. Suggestion box: this category implies that patients should be provided a chance to

give suggestions to improve hospital services in general and to promote good

relationships among patients. It has to be noted that hidden between the lines in this

category‟s answers is a reaction against government hospitals. It is the most important

issue that was pointed and observed by the doctors. Its frequency value is 63.

8. Continuous monitoring: the respondents in this category are of the view that

continuous monitoring of hospitals by EDO Health is mandatory. Its percentage is 31%.

9. Interaction: it means that greater interaction is essential with patients as it helps

doctors to build up strong mutual relationships which minimize miscommunication. Its


10. Patient education: it means education of patients in health literacy. It is a very

important factor whose absence sometimes becomes dangerous during patient‟s

treatment. Its percentage is 20.

11. Female doctors: this factor suggests a need to provide female doctors to female

patients. It gives an opportunity to female patients for describing their health issues in a

better way. Its frequency value is 32.

12. Medical terminology/jargon: this factor suggests to, avoid using medical

terminology /jargon while talking to patients. It facilitates uneducated patients. Its

percentage is 16%.

13. Four language skills: the answers included in this category suggest that four skills

should be effectively taught to doctors during studies. The four skills will facilitate

doctors to handle patients in a better way. Its frequency value is 28

14. Provision of local doctors: the answers included in this category suggested the need

to provide local doctors to patients. This factor helps doctors to understand patients

better. Its percentage is 21.

15. Charts and Visual: this category shows that doctors should take help from charts

and visuals to be able to explain their treatment plan to patients more effectively. Its


209

16. Salary: this category implies a need to provide better incentives in the form of perks

and privileges. The percentage of this theme is 8.

Discussion

This question aimed to ask suggestions and measures which can reduce

miscommunication between doctors and patients. All the categories, whether closely

relevant or not, provide important information which may help in understanding different

dimensions of the topic of research. Therefore, those categories which are not closely

connected to the research have also been considered for the analysis. It is important to

note that there are many categories which are common among all respondents. It is due to

the fact that the respondents give them a lot of importance as key factors. Some

categories enlisted in the table are definitely irrelevant as answers to the given question

still they are significant in providing useful information in the same way as some did in

the first open-ended question. There are fourteen factors which have their percentage in

double figure and only two have their percentage in single figure. It can be found that a

remarkably higher number of the respondents gave suggestions and recommendations to

reduce miscommunication between doctor and patient.

The highest percentage of first category in the table i.e. listening highlights two

facts; first, a clearly greater number of respondents feel that poor listening skills create

miscommunication during consultation between doctor and patient; second the most

important cause of this miscommunication is due to the setting and location in which

consultation takes place. The results achieved here support the findings from the close-

ended items. It is one of those constructs in this study which have emerged as high-value

constructs.

The second most frequent theme is training in communication skills for junior

doctors by senior doctors. This theme underlined the need for in-service training in

communication skills to be provided to young doctors by senior doctors for them. Such

trainings may help doctors deal /treat/understand patient more effectively.

The third category labeled as „translator or interpreter‟ has very significant

statistical value. It was observed during doctor-patient medical discourse that a dire need

of translator or interpreter is required in government hospitals. Most of the patients were

210

unable to communicate completely while discussing their health issues with doctors.

Attendants and relatives of patients can also act as translator or interpreter to lower down

any miscommunication.

Burden of work was found to be a very important factor responsible for

miscommunication. Doctors do not have time to discuss in detail due large number of

patients. It is suggested that government should appoint more doctors to decrease this

number. Monitoring of doctors by EDO health is also very important factor which

improves the state of affairs. If possible female patients may be sent for medical checkup

to female doctors and male doctors to male patients. This factor also help patient to talk

confidently with doctors. It also maintains the element of privacy of patient with doctors,

and encourages greater interaction. Greater interaction in turn results in building better

understanding and relationship between doctors and patients. During interaction patients

must be educated in health literacy. It is very important to help patients realize the

importance of health. This factor will reduces miscommunication and help patients

understand their disease better. Charts and visuals can also help to explain the disease in

detail, enhancing patients‟ knowledge for better treatment.

Some doctors believe that increase their salary may help them work with greater

peace of mind. It was also suggested that local doctors may be appointed which may

overcome language and cultural barriers.

There are some other suggestions which cannot be given much importance due to their

low frequency which renders them insignificant. The discussion here furnishes answer to

research question number 3, 4 and 5.

4.4. Analysis of Interviews (Taken from Patients)

Structured interviews of 24 participants were conducted. The answers by the

participants in this regard and their interpretation have been given in the following. It is

important to mention that the answers by the participants were replete with linguistic

errors due to their low competency in English. No major changes were made in what was

said by them during the process of transcription except where it would render the text

nonsensical. It was done in order to keep it authentic to the maximum.

211

1. Q.1 How do you see language as communication barrier in government hospitals of

district Rawalpindi?

Ans1. I do not think it is a barrier in communication.

Ans2. I think sometimes this is a barrier in the way to get clear instructions from patients.

Ans3. Patients are unable to understand the medical treatment easily due to language

hurdle.

Ans4. In present circumstances, it is not a barrier.

Ans5. Government is taking steps to overcome this problem.

Ans6. Sometimes we face problems regarding language due to accent of doctors.

Ans7. No problem at all.

Ans8. Sometimes we face problem but mostly it is understandable.

Ans9. When they use medical terms we are unable to understand it.

Ans10. No comments.

Ans11: It is very difficult for the doctors to inform patients about their disease in second

language.

Ans12: No idea about this question.

Ans13: Not a good experience with doctors regarding language barriers.

Ans14: No problem in communication with patients.

Ans15: In my opinion communication barriers exist in doctor-patient interaction.

Ans16: No issue at all in communication.

Ans17: Sometimes we face problems in understanding.

Ans18: Good communication during consultation with doctors.

Ans19: Government of Punjab is trying to solve this problem very soon.

Ans20: Good interaction with doctors, no problem at all.

Ans21: It is fine, no problem to me.

Ans22: Doctors should talk in Urdu and only Urdu.

Ans23: No problem in language.

Ans24: It may exist if uneducated patient comes for treatment.

212

Discussion

It can be found that there are mixed responses to the questions aimed to elicit

feelings of the respondents. There are widely different suggestions in certain cases. It is

an obvious and a clearly dominant trend that patients are not facing problems regarding

language. Mostly they are of the opinion that language is not a barrier as far as

communication is concerned. Hence, it can be interpreted that the participants believe

that language no doubt is very important and useful during their consultation with

doctors.

Q.2 Do you think that the training in communication skills for the doctors can be

useful to improve doctor-patient interaction?

Ans1. Training is no doubt useful and helpful for improving doctor-patient interaction.

Ans2. Agreed

Ans3. Yes, it is mandatory for all doctors.

Ans4. Only training is not useful but guidance is also required from senior doctors.

Ans5. Yes of course, training for the young doctors will be beneficial for them.

Ans6. Training is practical for them.

Ans7. No, because the environment is obstacle in it.

Ans8. Yes

Ans9. Sure

Ans10. No

Ans11: It is very central to arrange training for the doctors. It is necessary. It will be

very useful and helpful for the newly appointed doctors.

Ans12: Training of doctors is very useful for them as most of our doctors are untrained

even after getting the degrees of MBBS.

Ans13: The training for the doctors should be purposeful.

Ans14: Yes, extremely it will be most valuable.

Ans15: I think the training of the doctors can be constructive.

Ans16: Yes.

Ans17: Yes, training can be handy.

Ans18: Yes, the training for the doctors excellent impact on them.

Ans19: Basic thing to motivate doctors is to make them conscious of the importance of

213

training.

Ans20: The training of the doctors will play positive role in their future life.

Ans21: Definitely, it should be according to the modern trend of medical profession.

Ans22: Yes.

Ans23: Sure, it could be done.

Ans24: Yes.

Discussion

The responses elicited through this question have maximum uniformity. The

question aimed to extract evaluation of the effectiveness of training provided to the

doctors. Details shows clearly that training is considered very useful and helpful.

However, certain restrictions to the suitability and use of training have to be understood

according to the participants. They suggest sort of specialization in this regard. There is

an observation that only training cannot serve the purpose well. There are other measures

and steps required to achieve the objectives of training.

5. Q.3 How far do you think that the patients feel threatened by the doctor’s

personality in government hospitals of district Rawalpindi?

Ans1. More than 60% patients are totally threatened or afraid of due to the personality

of doctors.

Ans2. Patients feel helpless in front of doctors due to their personality.

Ans3. A large number of patients feel threatened by doctors.

Ans4. The bad treatment by doctors is a great threat to patients.

Ans5. Patients of all age group really feel threatened due to the doctor‟s personality.

Ans6. It is true that senior doctors are a serious threat for patients.

Ans7. Some patients feel threatened whose qualification is low.

Ans8. I do not think that all the patients feel threatened by doctors.

Ans9. Not at all.

Ans10. No

Ans11: The patients feel threatened by doctors as they have no exposure for this.

Ans12: Most of the patients are threatened by doctors because majority of them don‟t

know about disease.

214

Ans13: Yes

Ans14: Almost 75 % patients feel threatened by the doctors.

Ans15: No.

Ans16: When they are not exposed for such purpose, they will feel so.

Ans17: Yes

Ans18: 100% correct.

Ans19: Yes.

Ans20: Majority of the patients consider this as a threat for them.

Ans21: I think there is a problem...

Ans22: Agreed.

Ans23: Yes.

Ans24: Yes

Discussion

This question is related to the personality of doctors. It was found that the patients

become afraid while talking to doctors during their consultation. Another important point

to be noted here is patients-related problems. Education counted as a relevant factor as

literacy of patients becomes hurdle in communication. Hence, educated patients had more

exposure to such situations and for this reason they are reported to be more comfortable

while discussing with doctors. There are few opinions that the patients do not feel

threatened at all. In the end, the point is that patients are afraid of due to doctors‟

personality.

Q. 4 What would you say about the speaking and listening skills of doctors towards

patients?

Ans1. Most of them are good at speaking and listening.

Ans2. We have problem in listening only as they are in hurry.

Ans3. No time for them to communicate in detail.

Ans4. Some doctors are very sympathetic and listen to us.

Ans5. Newly appointed doctors don‟t feel hesitation in asking various questions about

our disease but doctors of old age don‟t bother to do this.

Ans6. Doctors never listen to us completely.

215

Ans7. Some doctors listen to every word.

Ans8. Doctors are very busy so less time for talking.

Ans9. Some senior doctors are not showing good behavior regarding this policy.

Ans10. Doctors have no time to listen us effectively.

Ans11: Our environment does not support them to listen carefully to each patient.

Ans12: Good at speaking and listening.

Ans13: They use native language which is very good for patients.

Ans14: No comments.

Ans15: Agreed that we have some listening problems.

Ans16: Due to shortage of time most of the doctors are not concentrating on patients

properly.

Ans17: No

Ans18: Yes they listen when they have time.

Ans19: Good to have experienced doctors so that they may listen to us.

Ans20: Patients are not educated so they feel problem in listening and speaking both.

Ans21: All the patients are worried because doctors have no time to listen them.

Ans22: Doctors explain and share information with patients to increase their

understanding.

Ans23: Doctors are ready but mostly patients can‟t understand.

Ans24: Doctors are speaking two languages Urdu and native at a time.

Discussion

Again mixed responses can be found here. However, a dominant trend can be

identified in this case. The reaction of patients is considered by majority of the

interviewees as negative. The question here is more paying attention in terms of the

interest to know what patients feel to be the ground realities about it. Overall, it has been

found that the interviews with the patients have produced similar themes as have been

obtained from informal observation. Almost all the patients agree on this single point

that adequate training in speaking and listening skills for the doctors is required. Another

important point that has come in response to this question states that the patients worry

216

about their disease. The point rose by the respondents that more time should be given to

improve communication between doctor and patient.

2. Q.5 How far the jargon and medical terminology creating miscommunication

between doctor and patient?

Ans1. Serious problem regarding medical terminology.

Ans2. To some extent, especially in names of diseases. They should discourage it.

Ans3. The doctors are not taking pain to use simple terminology for patients.

Ans4. A few doctors are ready to explain these terminology if they have free time.

Ans5. New doctors are motivated and feel comfortable in translating these terminologies

in simple language i-e Urdu.

Ans6. Not doing

Ans7. I do not understand about jargon at all.

Ans8. Half of the doctors are willing and the others hesitate due to continuous hectic

schedule in government hospitals.

Ans9. No

Ans10. Not at all

Ans11: There is no such instruction for them to do it.

Ans12: Sometimes they do explain them.

Ans13: No impact on patients.

Ans14: Yes

Ans15: By telling patients the benefits of information.

Ans16: Doctors should be trained for this purpose.

Ans17: Doctors are not annoyed rather they want to explain in Urdu.

Ans18: Yes

Ans19: Yes it creates miscommunication.

Ans20: Yes

Ans21: Mostly doctors are not in habit of such practice.

Ans22: If the doctors are not selected on merit they will do the same.

Ans23: Yes, it creates miscommunication.

Ans24: Patients feel themselves in serious tension.

217

Discussion

It can be found that there is a variety of ideas related to this issue. However, it is

clear that a dominant majority of the patient according to the participants are found not to

be satisfied from doctors on this issue. Same idea has been noted in the data through

open-ended items. Many important reasons for miscommunication among patients in this

regard can be found in the answers. The most important among these is lack of

motivation. Doctors are not explaining these jargons in detail. In some situations, patient

becomes tense and worried about disease. Instructions regarding these medical terms

sometimes create misunderstanding in treating patients.

6. Q.6 What are your views about the location and setting during doctor-patient

consultation?

Ans1. Worst conditions

Ans2. Bad environment.

Ans3. I think there should be medical emergency declared in order to improve situation.

Ans4. Government of Punjab is improving it.

Ans5. Pathetic situation.

Ans6. No proper seating arrangements for patients.

Ans7. Government should make available such facilities with immediate effect.

Ans8. Do not ask me, please

Ans9. Very much improved now.

Ans10. No idea

Ans11: They should be given proper setting and atmosphere for this purpose.

Ans12: Punjab government is taking serious actions in this regard.

Ans13: Good arrangements in some offices only.

Ans14: Good work done by provincial government.

Ans15: Not happy at all.

Ans16: Satisfied now.

Ans17: Very pathetic situation

Ans18: No privacy for patient in government hospitals in whole country.

Ans19: I can only pray to God for improvement.

218

Ans20: Well done EDO health.

Ans21: It needs immediate action to improve the situation.

Ans22: Doctors have no other options in this regard.

Ans23: Agreed with seating and location issue.

Ans24: Sorry thing because of ill-planning and misunderstanding between the nation and

the rulers.

Discussion

This question aimed to elicit the present situation of government hospitals

regarding setting and location. The responses show clear trends. Situation is not good

according to most of the respondents. The opinions are phrased differently with similar

implication. Patients are not satisfied from the existing situation of setting and location.

Privacy plays a vital role in doctor-patient medical discourse which is unfortunately kept

in government hospitals of district Rawalpindi. The most hurting in this regard is that

health has never been a priority with the policy makers in this regard. The government of

Punjab at least is required to declare medical emergency in this regard. It needs to be kept

in mind that things will certainly require time to settle correctly. It is a gigantic and

important decision which, if has been taken, needs to be stood by otherwise the result will

be nothing more than another story of one more failure.

7. Q.7 Do you agree that the doctors’ gender effect in doctor-patient interaction?

Ans1. Yes, it matters a lot.

Ans2. Female doctors are more caring.

Ans3. Not a big difference

Ans4. Yes, male doctors are harsh

Ans5. Newly recruited doctors have full competency and confidence to handle any

gender.

Ans6. Not at all.

Ans7. Yes

Ans8. 70% doctors are treating both genders in the same way.

Ans9: Yes

219

Ans10: Yes

Ans11: No.

Ans12: No

Ans13: No, doctors are not confident enough to handle both genders.

Ans14: Almost 80% doctors are positive.

Ans15: Yes it makes a difference.

Ans16: I think no issue at all.

Ans17: I think majority of doctors are good to handle both genders.

Ans18: Male doctors are handling male effectively.

Ans19: Male doctors are treating female patient effectively as compared to male patient.

Ans20: Yes it is a serious matter to be looked for.

Ans21: No

Ans22: In villages it matters a lot.

Ans23: Yes, it is a problem in our society.

Ans24: Yes

Ans25: Yes, in villages they are facing a serious problem.

Discussion

The respondents are somewhat divided on this question but still a dominant trend

can clearly be seen indicating that the gender of doctors do make the difference. Majority

of the respondents think that most of the female doctors always show sympathetic

attitude towards patients while treating. Some respondents are of the view that male

doctors treat male patients properly as compared to female doctors. In villages, due to

culture bindings female patients prefer female doctors. However, in cities this problem is

not significant. Mostly doctors whether male or female equally handle patients with

different genders. In conclusion it can be said that gender of doctor as well as patient

matters a lot during medical treatment.

220

Q.8 How far the time (duration of consultation) is important for doctor-patient

communication?

Ans1. No proper time is given to patient.

Ans2. Majority of doctors do not have enough time for patient due to large number of

patients.

Ans3. Although doctors consider time as a very important for treatment but they do not

pay heed to it.

Ans4. They believe it important but the responses of patients disappoint them.

Ans5. No time for poor patients.

Ans6. More time should be given to patients.

Ans7. Doctors are at difficult position to give maximum time due to large number of

patient.

Ans8. In present situation, it is not possible.

Ans9: More doctors may be appointed to handle such problems.

Ans10: less doctors so time cannot be increased.

Ans11: Big problem as doctors are not giving time to us.

Ans12: Doctors are supposed to check 150 patients a day so it is not possible.

Ans13: Being professional they should give proper time.

Ans14: Senior doctors are not giving time to poor patients.

Ans15: Punjab government is trying to fix this problem.

Ans16: They think it important but unable to do it.

Ans17: Doctors who are not ambitious regarding their career give no time.

Ans18: Important issue to be solved.

Ans19: Time matters a lot.

Ans20: It is no, doubt we believe that time of consultation is very significant in doctor-

patient interaction.

Ans21: They consider it very important as they try to improve this situation.

Ans22: Maximum time results good medical treatment.

Ans23: Time is precious in every aspect of life.

Ans24: Yes, i think it is important for patient to tell his all details.

221

Discussion

There exists complete clarity in the trend of data here. It has been reported that

most of the patients consider time to be very important factor in doctor-patient

interaction. They are of the view that patient should be given enough time to discuss

his/her health issues in detail. They also complained that senior doctors are not giving

proper time to them. Newly appointed doctors are motivated and committed towards their

profession. A solution is also suggested that more doctors may be appointed to overcome

this problem.

4.5. Observation of Doctor-Patient Medical Discourse

Observation was also conducted by the researcher. Following points were

observed and analyzed:

1. Listening: listening is a very important skill in doctor-patient-medical discourse.

Good listening plays a significant role in building the understanding between the doctor-

patient interactions. It is observed that doctors are not properly listening to patients. They

simply observe/look at the patient to diagnose the disease. In case some patients want to

say something they simply stop them or ignore what they are saying. This results in

miscommunication and which creates problems in proper treatment of the patients. Due

to shortage of time and large number of patients doctors are also bound to speak less. In

tehsil Kallar Syedan and Kahuta listening problem is major source of miscommunication.

2. Training: Training in communication skills is one of the important and significant

components during medical profession. Trained doctor regarding communication skills

always perform better as compared to untrained. Trained doctors handle patients

effectively to establish better relationship. Young or newly appointed doctors sometimes

face communication problems. Doctors of tehsil Taxila need to be trained in

communication skills. It is suggested that workshops and seminars on communication

skills must be arranged for doctors on regular basis, since workshops/seminars improve

doctors‟ relationship with patients.

3. Translator /interpreter: Due to illiteracy among patients doctors face a lot of

problem in getting complete information about disease of the patient. In order to solve

this major issue doctors need to have a translator or interpreter during medical treatment

222

process. Most of the illiterate patient are also facing problem in explaining their diseases.

Sometimes their relative performs that role to facilitate both doctor and patient in this

regard. A dire need for translator /interpreter is required in government hospitals of tehsil

Gujar Khan and Kotli Sattian.

4. Workload of doctors: Average workload of doctors for checkup in all tehsils is

almost 200 patients per doctor. This is very high and is a big cause of miscommunication.

Punjab government should take necessary steps to reduce this workload by appointing

more doctors in all tehsils. More time should be given to a patient so that he/she may be

in a position to talk freely and completely. It is also recommended that new hospitals and

private clinics be opened so that patients have more options of treatment.

5. Time: Time of consultation plays a vital role in doctor-patient interaction. It should be

appropriate according to the situation. Most of the patients have habit to extend their

discussion to unlimited time which sometimes wastes precious time of doctors. But in

government hospitals of district Rawalpindi time is a major problem. Doctors have not

enough time to deal effectively to each individual due to a large number of patients.

Greater interaction is essential with patients as it helps doctors to build up strong mutual

relationships which minimize miscommunication.

6. Continuous monitoring: The continuous monitoring of hospitals by EDO Health is

very important and it should be mandatory. Surprise check by EDO will definitely

improve the overall condition of government hospitals in district Rawalpindi.

7. Patients’ education: Patients‟ education in health literacy is a very important factor

whose absence sometimes becomes dangerous during patient‟s treatment. But

unfortunately this factor is very much observed in government hospitals of district

Rawalpindi that patients have no basic education about health. Some steps like

campaign/walks regarding various health issues may be arranged by health department.

8. Provision of local doctors: It was much observed during consultation between doctor

and patient that there is a need to provide local doctors. This factor helps doctors to

understand patients better. It is suggested that female doctors may be provided to female

patients. It gives an opportunity to female patients for describing their health issues in a

better way.

223

9. Medical terminology/jargon: This factor suggests avoiding using medical

terminology /jargon while talking to patients. It facilitates uneducated patients. Doctors

should take help from charts and visuals to be able to explain their treatment plan to

patients more effectively. Health literacy is one of the most important issues. Doctors

should know the level of education of the patient and should explain their condition. In

this process relatives and staff can help as interpreter or translator to make patient

understand about their disease and other information about diagnosis.

10. Attitude: The attitude and behavior of doctors must be changed towards patients. The

prevailing situation at tehsils hospitals of district Rawalpindi demands that doctors should

be polite, kind and sympathetic towards their patients. This brings a lot of positive effects

on the overall conditions of hospitals. Doctors‟ negative attitude which includes

arrogance and rudeness towards patient is a major hurdle in effective communication.

One possible cause could be the hectic schedule of doctors as doctor patient ratio is really

high in government hospitals of district Rawalpindi.

11. Setting and location: Patients should be provided a comfortable/relaxing

setting/location during consultation. It has been observed that privacy is not maintained

during doctor- patient interaction in government hospitals of district Rawalpindi. This is

mandatory to be done in doctor-patient interaction. Doctors must educate patients on

medical treatment plan. It helps patients to understand and know about their disease and

its precautionary measures. This is only possible if privacy can be maintained. It requires

conducive environment for effective communication that can be possible only if proper

seating and location is provided to patients and doctors both. It is also realized that

seating arrangements in waiting area for patients should be improved. The noisy

environment during consultation of doctor can also act as communication barrier. Patients

should be provided comfortable and relaxed settings for mutual consultation. It is one of

the most important issues pointed and observed by the researcher while visiting in

government hospitals of district Rawalpindi.

12. Gender: It is an important factor which can act as barrier in doctor-patient medical

discourse. It is very much observed that mostly in government hospitals male doctors are

present on duty to check patients in OPD. Which sometimes create a sort problem while

224

examining female patients. Female patients are reluctant to share information with male

doctors. This leads to miscommunication and results in incomplete medical treatment of

female patients. It was observed that male doctors give more time for interviewing

female patients but on the other hand female doctors are more caring and responsible

enough to ask more questions from male patients. One important factor which helps the

patients at ease is professional experience of doctors. Experience doctors handle such

situations effectively. It is an important indicator to understand miscommunication issues

in medical setting.

4.6 Summary

This chapter dealt with presentation, analysis, and interpretation of the data

collected for the study. It was divided into five main parts. First part contained analysis of

data gathered through demographic information in the questionnaire responded by

doctors. Second part included analysis of data gathered through close-ended questions in

the questionnaire responded by doctors. Third part consisted of analysis of data gathered

through open-ended questions and the fourth included analysis of the data collected

through interviews taken from patients. The last and final part presented the analysis of

observation of doctor and patient interaction conducted by the researcher. The closed

ended statements of questionnaire were analyzed quantitatively by using SPSS version

21. The qualitative data which included interviews and informal observation was

analyzed by using the technique of thematic categorization and labeling. Discussions

were done to interpret the data for findings to reach the conclusion.

The next chapter deals with findings, conclusion and recommendations.

225

CHAPTER V

FINDINGS, RECOMMENDATIONS, AND DISCUSSION

This chapter concludes the study. It provides a comprehensive summary of the

introduction, methodology, analysis and interpretation of the data in the light of existing

literature in the area. Findings of the study have also been provided in this chapter along

with the recommendations for solution to miscommunication observed in government

hospitals of district Rawalpindi. Some suggestions have been made for future researches

on the basis of the findings of this study.

5.1 Summary

The primary aim of this study was to explore the communication barriers in

medical setting at government hospitals of district Rawalpindi. In the second place,

miscommunication was observed with the help of both linguistic as well as social factors

and Miller model (2002) was adapted as the theoretical framework for this study. The

issue of miscommunication has been ignored and had never got the focal position in the

health policies of Pakistan. It all depended on the particular vision and inclination of the

ruler/s of the time. Different health policies over time gave it different twist in health

education. In face of all such vicissitudes miscommunication remained a very crucial

problem in government hospitals of Pakistan. The policy of government of Punjab can be

seen as an effort or step towards the end of this issue. The conduct of trainings, seminars

and workshops had tried to minimize this issue. New appointments can minimize the

workload of doctors. Still, the problems involved in it cannot be overlooked.

The study was designed to examine the doctor-patient medical discourse at

government hospitals of district Rawalpindi. The main research objectives were: to

examine the demographic information of doctors serving in government hospitals of

district Rawalpindi, to identify the linguistic factors that cause misunderstanding and

226

misinterpretation between doctor and patient during medical examination, to explore the

social factors which affect communication between doctor and patient during medical

treatment, to discover whether the problem exists in doctors' communication with patient,

and to suggest solutions to communication barriers which affect the quality of doctor-

patient medical discourse in government hospitals of Rawalpindi district. For this study,

eight tehsils of district Rawalpindi were taken as sample. A questionnaire on five-point

scale was constructed to obtain the views of doctors about the doctor-patient medical

discourse.

The data gathered can be divided broadly into two categories on the basis of its

nature while its analysis was done in different parts corresponding to the research

questions raised in this study. Data on the basis of its nature can be classified as narrative

and qualitative. Narrative data was collected through open-ended items of the

questionnaire and quantitative data collected through close-ended items. A questionnaire

was constructed for doctors working in government hospitals. The questionnaire was

divided into four parts. Part A included demographic information about doctors, Part B

contained linguistic barriers in doctor-patient relationship, part C contained social

barriers, which become a hindrance in communication between doctor and patient and

Part D had open-ended questions for doctors to improve their relationship and minimize

miscommunication with the patients. On the other hand, analysis can roughly be divided

into four parts. The first part includes data gathered through demographic information in

the questionnaire. The second part includes data gathered through close-ended questions

in the questionnaire. The third part consists of analysis of data gathered through open-

ended questions and fourth includes analysis of data collected through interviews.

Analysis of data through close-ended items was further divided into two parts.

1. Frequency and percentage analysis of data collected on each item separately to

see variation on the basis of three demographic factors i.e. sex, marital status, and

professional experience.

2. Construct wise analysis of data showing in percent the number of the respondents

with high, medium and low level of intensity with each construct.

Each part of the analysis was used for its respective purpose. In the first part

single item analysis was done to find an answer mainly to research question number 2

227

which aimed at knowing how far demographic features could affect communication.

Professional experience (PE) in this connection was found to be the most significant

predictor of the motivation level of the participants while gender and marital status were

found to be significant in relatively fewer cases. However, out of the later two, marital

status emerged as more important in close-ended data, which was cross-validated by the

open-ended or narrative data as well. Construct wise analysis was made to know

differential tendencies in nature of the participants. Percentage and frequency analysis

was used to explore the relationship between different selected constructs. It was found

that the constructs, in their tendency to group distinctively into two, showed relatively

higher mutual correlations than with the cross group constructs. Finally open-ended items

and interviews were used to explore the matter in greater depth and to cross-validate the

findings from close-ended part of the questionnaire. This intensive exercise on data

analysis produced important results in this study. It provided worthwhile insight into the

situation. Following are the findings accrued on account of data analysis.

5.2 Findings and Data Interpretation

1. Majority of the participants (doctors) have positive attitude that the language is

predominant instrument by which information can be transmitted. They are of the

opinion that language is the initial step which starts communication process.

Doctors are aware of the fact that their choice of words affects communication

between doctor and patients. Being good at communication is not against their

profession and by having good communication skills they can better explain

information about diseases and medicine to their patients. It means that barriers of

language should be overcome for smooth and uninterrupted consultation. Language

barrier in any case should not become hindrance between doctor and patient during

consultation.

2. Almost all the doctors do not think that language barriers occur when people do not

speak same language. However, a dominant majority of them believes it to be a good

policy for the future provided some necessary steps are taken or preparations made.

Using visuals and non-verbal expressions can help to reduce the language problems.

Due to illiteracy regarding health in our country, majority of the patients have

228

problem in speaking. Patients of remote area have no access to government health

campaign and other related arrangements. It is a dire need to arrange health awareness

campaign and programs in the remote areas of district Rawalpindi. In tehsils

specifically Kahuta, Kallar Syedan, and Murree, patients need more attention as

compared to Tehsil Gujar Khan, Taxila and Rawalpindi.

3. Doctors realize more positively the importance of good communication skills, its

pivotal role and the promises it carries due to such a role. They strongly feel the need

for doctors to have mandatory training of communication skills. Communication will

not only help doctors to have good discussions with patients, it will also help them to

gather and share more information. Training in communication skills lacks in some of

the doctors of tehsil Taxila and Gujar Khan. Patients sometimes feel shy while

sharing information with doctors. Doctors should motivate patients, to speak, and

share their problems with complete confidence. It can only be done if doctors are

properly trained to handle such situations. Young doctors have to undergo mandatory

training in communication skills which may be conducted by qualified and

experienced doctors. Mostly doctors feel that having communication training will

help them to understand the patient‟s perspective and they will be able to conclude

the interaction sessions better.

4. Five things have been given key importance in doctors‟ communication. The first and

foremost among these is spoken language of the doctors, the second is accent of

speech used by them, the third is their pace of speech , the fourth is verbal expression

(tone, pitch) and the fifth is quality of their voice. Accent was the major issue in all

most all tehsils of district Rawalpindi where patients were not in position to

understand the Urdu language. Most of the patients were illiterate and have no basic

education. Some doctors of Murree and Kallar Syedan tehsils have voice problem i.e.

they speak in low voice which is not audible in the presence of so many patients.

Tone and pitch play a vital role in motivating patients to share their maximum

information with doctors.

5. Doctors agree that listening attentively creates partnership between doctor and

patient, and unwillingness to listen to the patient can affect the quality of doctor-

229

patient communication. On the contrary, poor hearing of patients is also a barrier to

effective listening for doctors. In the meantime, preoccupations like eating, working

can divide attention and affects communication between doctor and patient. These

problems are very much found in most of the tehsils of district Rawalpindi. Both

doctors and patients are responsible for creating this barrier.

6. Mostly doctors admit that medical terminology creates miscommunication if used

frequently, and it can act as a barrier in doctor-patient medical discourse. Majority of

the doctors believe that patients fail to understand the meaning of jargons, and thus

jargon act as a harmful indicator for medical treatment of the patients. A small

percentage of doctors do not agree, in their opinion jargons are not that important to

have effective communication sessions with the patients. Mostly patients of remote

area are facing this problem.

7. Language, doctors‟ training in communication, speaking proficiency, listening

comprehension and excessive use of jargons come out to be major linguistic factors,

which affect doctor-patient medical discourse in medical settings.

8. A strong futuristic belief has been traced among the participants about better

proficiency among doctors. It was inferred from the views of the doctors that newly

appointed young doctors were better in their understanding about proficiency. They

were also reported to be relatively more motivated to develop their skills and more

interested in taking measures to handle proficiency issue.

9. Gender has not proved, overall, to be an important factor of difference to find the

impact of social and linguistic factors acting as a barrier in doctor-patient medical

discourse. It is found significant in only 25 out of a total of 55 items. Gender has not

been pointed out as relevant factor anywhere in the open-ended data as well.

10. In the items where gender remained significant male and female respondents were

found to be equally motivated to overcome factors responsible for miscommunication

issues between doctors and patients.

11. In marital status-based responses, majority of positive responses are given by the

single participants and this category of construct emerged as good indictor to know

about the communication problems in medical settings.

230

12. Professional Experience has proved to be very important indicator of motivation and

positive attitude toward communication barriers issues. It has been found significant

in close-ended items.

13. Professional experience overall is reported to be an important indicator to understand

the miscommunication issues in medical settings. In close-ended part it has been

found mildly significant only in 26 items and highly significant in 29 items. Highly

varied percentages of responses are gathered from participants belonging to different

groups.

14. It is found that gender sometime affects communication. Male doctors spend more

time interviewing female patients; on the contrary, female doctors are more caring

and ask more questions and facilitate patients. In open-ended questions, it is

suggested that female patients should be provided with female doctors, in this way

they can better discuss their health issues.

15. Doctors‟ negative attitude (arrogance, rudeness) towards patient is a big hurdle in

effective communication. One possible reason could be the hectic schedule of doctors

as doctor patient ratio is really high in government hospitals. A majority of doctors

agree that they should be more kind and considerate while communicating with the

patients and should be good listeners.

16. Privacy issue of doctor-patient meetings is another grey area that becomes a hurdle in

better communication of the two. Usually relatives accompany patients and the

patients avoid sharing details of their illness in front of other family members. As a

result of miscommunication, patient fails to give full description of disease, which

becomes a major hurdle in diagnosis and prognosis. Seating facility and location in

government hospitals is very pathetic and there is no privacy at all. Patients are bound

to disclose their health issue publically which they do not. This leads to

miscommunication between doctor and patient.

17. Time is found to be a very significant factor to affect relationship of doctor and

patient. The length of available time for the consultation has direct affect in nature of

discussion between doctor and patient. However, it has shown no direct causative

influence on diagnosis of patients. But it was very much observed that patients need

231

more time from doctors. At the same time doctors have to attend more than 150

patients per day. It practically bounds them to give minimum time to each patient.

18. The noisy environment during consultation of doctor can act as communication

barrier. Patients should be provided comfortable and relaxed settings for mutual

consultation. It is one of the most important issues pointed and observed by the

doctors serving in government hospitals. Some administrative steps should be taken

to overcome this barrier.

19. Health literacy is also one of the most important issues. Doctors should know the

level of education of the patient and should explain their condition in consideration of

that level. In this process relatives and staff can help as interpreter or translator to

make patient understand about their disease and other information about diagnosis.

5.3 Fulfillment of Objectives

The objectives of this study have been achieved. The main objectives of the study

were to identify social and linguistic factors, which play their role in effective

communication between doctors and patients during process of medical examination. It

has been found that the doctors are aware of social and linguistic barriers existing in

healthcare system, but they are unable to solve the issues on their own. Another major

objective of this research was to suggest solutions to communication barriers. There is

need for professional communication training for doctors to overcome the lapses found in

the medical settings, which can become a hurdle in doctor- patient communication.

However, there is need for policy making to improvise the healthcare system in

government hospitals.

5.4. Contribution of the Study

Miller (2002) proposed a conceptual framework model that explains that patient,

provider and contextual characteristics influence the nature and content of provider

communication and it also affects various health outcomes. Present research was based

on the conceptual framework provided by Miller, although this model was initially used

for telemedicine setup, I tried to see the application of this model in local medical

settings.

232

Figure 5.1 Miller’s Conceptual Framework

The contribution of this study can be seen in the following two ways;

1. It has successfully tested the conceptual framework model, which was advocated

by the founder of this model. By selecting 5 linguistic and 5 social variables

suggested by the presenter of this model, I tried to find the responses of

participants and to identify problematic areas.

2. This study has tested and confirmed that linguistic and social factors are major

communication barriers between doctors and patients.

On the contextual level this study has made contribution by studying problems of

the doctors from 8 tehsils of district Rawalpindi. It has highlighted ground realities and

the problems face by the doctors. This issue has always been critically important in

government hospitals of Rawalpindi. So, it has made worthwhile contribution by

bringing into focus the issues of the key stakeholders having pivotal role in success or

failure of this healthcare system. This study provides insight into the insidiousness of

faulty communication as a contributor to medical mishaps. My findings are consistent

with the research conducted by Miller, which shows a strong link between poor

communication, and errors with linguistic and social barriers.

This research will enable the policy makers to realize the importance of

communication barriers in health sector and take some measures to improve this area

along with normal health practice. It will raise the awareness of in practicing staff for the

233

creation of patient- friendly „linguistic code of conduct‟ that will bring ease and provide

with simplified ways for the academically poor patients.

5.5. Recommendations

1. Government should make training of communication skills mandatory for medical

profession. Workshops and seminars should be arranged for newly appointed

doctors to improve their oral communication skills while interacting with patients.

Training on communication skills may be given to doctors during their studies.

2. There is a requirement for more congenial environment in our government

hospitals. The doctors should minimize use of jargon/ medical terms in order to

make patients more comfortable.

3. The focus of government should center more on health literacy of patients.

Increasing health literacy among patients will help improvise healthcare

system.

4. Appointment of multilingual or locals can be a good gesture to improvise the

communication issues in healthcare systems. Hiring interpreter/translators can

also be helpful to overcome the miscommunication issues. Relatives of patients or

nurses can play the role of interpreter because it is not feasible for government to

appoint interpreters/translators for government hospitals at once.

5. Doctor-patient ratio is really high in the government hospitals. Doctors who are

serving in government hospital have to examine an average of 150 patients per

day, so doctors are always in hurry to finish their work and are unable to

provide enough consultation time to each and every patient. As a result, lack of

communication occurs and both the doctor and the patient fail to discuss severity

of illness. Therefore, there is need to appoint more doctors in government

hospitals, in this way doctors will be able to give ample time to each patient.

6. Location and settings also play major role in proper communication of doctor and

patient. Usually, in government hospitals, there are few waiting areas and patients

wait for their turn in corridors. Government should make more waiting areas in

234

hospitals, it will make corridors less noisy and doctors and patient can discuss

issues in a better way.

7. There is need for more hospitals in the city. Population of district Rawalpindi is

increasing at rapid rate but unfortunately the number of hospitals is not enough to

cater for this big population. There is need for more clinics and hospitals, which

will divide the burden of government hospitals, and it will have a good impact on

overall health issues of patients.

8. Government should give incentives that are good at dealing with patients from

diverse backgrounds. There should be suggestion box in hospitals for patients, it

will help the management address consultation issues and measures can be

taken to sort out problems.

9. Doctors having highly proficient language should be hired for cities having

diverse background population. Attractive salaries should be offered to the

doctors in government hospitals. If doctors are satisfied with their pay package,

they will have greater willingness for work and will not do part-time jobs. This

will help improve the healthcare system.

10. Government and policy makers should conduct health awareness programs and

talks at different forums and should encourage patients to provide full information

and ask questions from their physician for proper diagnosis.

5.6 Suggestions for Future Researchers/Researches

1. A very important area for future research can be the effectiveness of training

being provided to the doctors serving in government hospitals of Rawalpindi to

answer three broad questions:

a) How far have such trainings been successful in equipping the doctors with

adequate skills to be able to communicate with patients effectively?

b) How far have these trainings been successful in motivating the doctors to be

better listener and better communicator?

c) What are the possible reasons in case of failure of such trainings?

235

2. It is suggested for future researches to conduct observation of doctors and patient

to have better understanding of miscommunication problems faced by the doctors.

3. An exploratory study can be conducted to discover the nature of problems faced

by the patients at time of doctor consultation. For this purpose, patients visiting

government hospitals can be interviewed to see other side of the picture.

4. A comparative study of government and private hospitals can be conducted to see

the impact of better medical settings on diagnosis and prognosis of patients.

5.7. Limitations of the Study

1. This study contains views and problems faced by doctors and also contain feedback

from patients. In order to have better understanding of patient-doctor communication,

there is need for research, which records consultation between doctors and patients as

well.

2. This study focused only social and linguistic factors. Only five linguistic factors i-e

language, doctor‟s training in communication, speaking proficiency, listening

comprehension, jargon/medical terminology and five social factors like gender,

personality, location and setting, time, and education were examined during this

research. Cultural, physiological, semantic and syntax factors may also be explored.

3. The study has been to a certain extent restricted in its purview or scope due to its

dependence on the selected model. A comparative study of different conceptual

models would give better understanding of the problem.

4. The number of patients was limited; a bigger sample can be studied to see if it has

some different responses of participants.

5.8. Discussion

This study revealed that doctors were somehow aware of the linguistic and social

communication issues and might be trying to overcome these problems in their individual

236

capacities. Doctors use excessive jargons in verbal and written communication, therefore,

a great number of the patients fail to understand information given by the doctors. It is

mainly because doctors are habitual of using jargons in their speech while studying

medicine and continues same practice in doctor-patient interaction; patients, in this

scenario, feel shy to ask question or fully share information to avoid any kind of

embarrassment. To develop a better doctor-patient relationship, time is an important

factor. Doctors in government hospitals have to examine 150 patients per day; it is very

difficult for the doctors to give proper time to patients. As a result, the purpose of

healthcare partially fails to satisfy patients. Lack of communication between doctors-

patients adversely affects both sides; patients feel himself to be inferior to doctors. On the

other hand, doctors take patients‟ silence as his satisfaction. Due to poor communication

between the two, the patient avoids going to hospital again as h/she doesn't want to get

embarrassed in front of doctors. As a result, disease is not cured or gets even worse and

here comes the failure of medical settings. Miller‟s model shows that patient, provider

and contextual characteristics are equally important for the success of healthcare system.

Situation gets worse when illness is not cured properly and become chronic. Its

implications are of much importance for the strategic plan designed by the government.

They have somehow or the other to be dealt with in such a way as not to be a hurdle in

the way of this policy otherwise they can be a serious threat to its success. The doctors

need communication training, which should be helpful in dealing patients from diverse

backgrounds. The level of patient‟s education leads to severe problems. Patients, who are

health-literate, are better at communicating with the doctors. Primary education should be

made compulsory for all citizens. Getting basic education will not only raise the literacy

rate of the city, it will also help minimize the communication problems at different

forums and especially in medical settings. On the contrary, communication gap between

doctors and patients cannot be reduced until both sides play their part effectively. Doctors

should be well aware of the education level of patients; they should have great

willingness to satisfy their patients and to develop trust relationship with them. If patient

trusts his/her doctor then s/he will freely share his/her pains, symptoms and problems

with the doctor. Doctors should have very good oral communication skills in order to

237

deal with different types of patients. Humbleness in attitude is yet another important

factor which can help doctors in develop trustworthy relationship with patients.

In absence of professional interpreters and translators, doctors should take help

from staff like nurses, ward boys etc. The sole purpose of doctors should be to have full

understanding of the patient‟s disease, as any carelessness from doctor can result in

serious health issues. Senior doctors should be cooperative to new doctors and should

guide them about problematic situations and communication issues in the hospital. Rude

and arrogant attitude of doctors can become a hurdle in making medical operations

successful.

The communication barriers, sometimes, become harmful, if not overcome.

Listening is a very important skill in doctor-patient medical discourse. Good listening

plays a significant role in building the understanding between the doctor-patient

interactions but it was observed that doctors were not properly listening to patients. They

simply observed/looked at the patient to diagnose the disease. In case some patients

wanted to say something they simply stopped them or ignored what they were saying.

This resulted in miscommunication which created problems in proper treatment of the

patients. Also it becomes mistrust on the part of doctors by patients. Most of the illiterate

patient were also facing problem in explaining their diseases. Sometimes their relatives

perform their role to facilitate both the doctor and the patient. But this practice

sometimes has adverse effects as privacy of information of the patient is to be kept in

mind. Time is an important factor during doctor-patient interaction and it has very serious

consequences if proper time is not given to a patient. Patients are totally depending on

doctors as they have to ask questions as and when required. If doctors are not giving

enough time to their patients then problems may arise in diagnosis. The noisy

environment during consultation of doctor can also act as communication barrier. The

comfortable environment is mandatory for effective communication. If the corridors of

the hospitals are noisy then miscommunication will definitely prevail. It creates listening

problem both for doctors and patients. This will definitely have an effect on

understanding of the patient. If the numbers of hospitals are not increased well in time

then more problems will arise and doctors will have to see more patients on daily basis.

The training in communication skills is to be added in medical courses so that once they

238

are in practical life they have less communication problems. It will definitely save their

time and resources.

Globalization is a wide-spreading phenomenon. People are moving from rural

areas to cities and cities are becoming multicultural and diverse communities are living in

big cities now. Globalization has changed the competencies and professional

requirements of individuals. As cities become more populated and diverse, there is need

for professionals who are multilingual, effective in communication with different

communities, efficient workers and good at professionals. There is need to prepare

doctors who can adjust themselves in this globalized age and provide better health

services.

REFERENCES

Arnold, R. M. (2003). Do we really care about doctor-patient communication or is it just

talk? Journal of Palliative Medicine. 6(2)189-192.

Berlin, E.A. & Fowkes, W.C. A. (1983). Teaching Framework for Cross-cultural Health

Care Application in Family Practice. West Journal of Medicine.139(6) 934–938.

Bird, J., Cohen-Cole S. A. (1990). The three-function model of the medical interview. An

educational device. Advances in Psychosom Medicine. 20:65-88.

Bühler, K. (1879). Theory of Language: the representational function of language/Karl

Buhler; translated by Donald Fraser Goodwin, in collaboration with Achime

Eschbach.

Baker, D.W., Hayes, R.Fortier, JP (1998) . Interpreter use and satisfaction with

interpersonal aspects of care for Spanish-speaking patients. Medical Care.

36(10)1461-1470.

Canale, M. (1983). From communicative competence to communicative language

pedagogy. In Richards, J. C., & Schmidt, R. W. (Eds.), Language

and Communication, 2-27. London: Longman.

Chandler, D. (1994). The Transmission Models of Communication. University of

Western Australia. Retrieved 25-12-15. (Shannon Weaver model)

Crystal, D. (1992). An Encyclopedic Dictionary Of Language And Languages. Oxford:

Blackwell.

Cooke M.W. , Wilson, S., Cox, P. Roalfe, A. (2000). Public understanding of medical

terminology: Non-English speakers may not receive optimal care. Journal of

Accident and Emergency Medicine. 2000;17:119-121.

Coupland, N., Giles, H., and Wiemann, J. M. (Eds.). (1991). "Miscommunication"

and Problematic Talk. London: Sage Publications.

David, R.A., Rhee, M. (1998). The impact of language as a barrier to effective health

care in an underserved urban Hispanic community. The Mount Sinai Journal

of Medicine.1998; 65(5-6):393-397.

DeVito, J. A. (1986). The communication handbook: A dictionary. New York: Harper &

ow.

Dew, K., Dowell, A., Stubbe, M., Plumridge, E., and Macdonald, L. (2008). 'Treating'

patients differently: a qualitative study of how clinical and social factors shape

interactions between doctors and patients. New Zealand Family Physician, 35(6)382-

386.

Drew, P. Heritage, J.,(1992). Analyzing Talk at Work: An Introduction. In

Paul Drew and John Heritage (ed.) Talk at Work. Cambridge: Cambridge

University Press, 3-65.

Ecker, P. and McConnell-Ginet, S. (1992). Communities of practice: where language,

gender, and power all live. Women and Language conference Berkeley: Berkeley

Women and Language Group, 89-99.

Etymology Dictionary Online. (2008). Doctor and Patient. Retrieved July 22,

2013, from http://www.etymonline.com.

Faux, N.R. (2002). Receta Medica: Communicating Medication Information across

the Language/Literacy Divide. Adult Learning: Health Literacy in Adult

Education, 18-20.

Fernandez, A., Schillinger, D., Grumbach, K., Rosenthal, A., Stewart, A., Wang, F. &

E. Perez-Stable. (2004). Physician Language Ability and Cultural Competence:

An Exploratory Study of Communication with Spanish-Speaking Patients. Journal of

General Internal Medicine, 19(2): 167-174.

Foucault, M. (1973). The Birth of the Clinic, (trans. A. M. Sheridan Smith), Tavistock,

London.

Freidson E. Profession of medicine: A study of the sociology of applied knowledge.

New York: Dodd, Mead & Company, New York, 1970.

Gay, L.R., Mills, G.E., & Airasian, P. (2009). Educational research (9th

ed.) Upper

Saddle River, NJ: Pearson Education.

Ghauri, P. N., Grønhaug, K. & Kritianslund, I. (2005). Research methods in business

studies: A practical guide. Prentice Hall: Dorchester.

Gumperz, J. (1982). "Social Network and Language Shift." In Gumperz, Discourse

Strategies. Cambridge: Cambridge UP, 1982. 1999. 38-58.

Halliday, M.A.K. (1973). “The Functional Basis of Language”. Basil Bernstein, (ed.)

Class, Codes and Control Vol. 2: Applied Studies towards a Sociology of

Language. London/ Boston: Routledge & Kegan Paul. pps.ix-xvi, 343-366.

Reprinted in Halliday, M.A.K. & Jonathan Webster. 2003. On Language and

Linguistics. Collected Works of M.A.K. Halliday, Vol. 3. Edited by Jonathan

Webster. Continuum.

Halliday, M. (1975). Learning How to Mean: Explorations in the Development of

Language. London: Edward Arnold, 1975.

Hamilton, W., and Britten, N. (2006). Patient agendas in primary care. British

Medical Journal, 332(7552), 1225-1226.

Heritage, J., and S. Sefi. (1992). Dilemma of advice: Aspects of the delivery and

reception of advice in interactions between health visitors and first time mothers.

In talk at work, edited by P. Drew and J. Heritage, 359-417. Cambridge:

Cambridge University Press.

Heritage, J. & Maynard, D. (2006). Problems and Prospects in the Study of

Physician-Patient Interaction: 30 Years of Research. Annual Review of Sociology,

32, 351-74.

Holmes, J. and Stubbe, M. (2003a). Power and Politeness in the Workplace: A

Sociolinguistic Analysis of Talk at Work. London: Longman.

Hughes J. (1994). Approaches to the Doctor-Patient Relationship. Organization and

Information at the Bed- Side.

Hymes, D. H. (1974). Foundations in sociolinguistics: An ethnographic approach.

Philadelphia: University of Pennsylvania Press.

Hymes, D. (1972). Models of the interaction of language and social life. In J.

Gumperz & D. Hymes (Eds.), Directions in sociolinguistics: The ethnography of

communication (pp.35-71). New York: Holt, Rhinehart & Winston.

Jalal, Z. (2009). Emergency Medical Systems: Pre-Hospital Trauma Care for

Landmine and Ordnance Blast Injuries іn Afghanistan. Ph.D. Dissertation,

University οf Phoenix, United States, Arizona. Retrieved April 17, 2014, from

Dissertations & Theses @ University οf Phoenix.

Jefferson, G. (1992). The rejection of advice: managing the problematic

convergence of a "troubles-telling" and a "service encounter". In P.

Drew and J. Heritage (Eds.), Talk at Work: Interaction in Institutional

Settings (pp. 521-548). Cambridge: Cambridge University Press.

http://www.continuumbooks.com/book_details.cgi?bid=12260&ssid=EUE50NVOL3A4M050F2XAAK

http://www.continuumbooks.com/book_details.cgi?bid=12260&ssid=EUE50NVOL3A4M050F2XAAK

John L. Coulehan, Marian R. Block (2006). The Medical Interview: Mastering Skills

for Clinical Practice: Medical Interview. F.A. Davis Company. ISBN

080361246X, 9780803612464.

Kennedy, I. (1981). The unmasking of medicine. London: George Allen and Unwin.

Kleinman, A. (1980). Patients and healers in the context of culture: An exploration of

the borderland between anthropology, medicine, and psychiatry. Berkeley:

University of California Press (patient doc exp model).

Kleinman, A., & Benson, P. (2006). Culture, Moral Experience and Medicine. Mount

Sinai Journal of Medicine. 73(6) 834-9.

Leigh, E. (2013, March 6). Opening a patient interview: Part II, your powerful first

few questions.

Linell, P. & N. Korolija. (1995).On the division of communicative labour within

episodes in aphasic discourse. International Journal of Psycholinguistics. 143-

165.

Lupton, D. (2003). Medicine as culture: illness, disease and the body in Western

societies. London: Sage Publications.

McCrum-Gardner E. (2008). Which is the correct statistical test to use? British

Journal of Oral Maxillofacial Surgery 46: 38–41.

Miller, E.A. (2002) Telemedicine and doctor-patient communication: A theoretical

framework for evaluation. Journal of Telemedicine and Tele-care.8, 311-318.

Mumby, D., & Clair, R.D. (1997). Organizational Discourse. In T. van Dijk (Ed.),

Discourse as Social Interaction: Discourse Studies Volume 2 - A

Multidisciplinary Introduction (181-205). Newbury Park: Sage.

Nadir A. (2003). Deficiencies of Medical System in Pakistan. Pakistan Journal of

Medical Education, 9.

Osler, W. (2008). Wikipedia Online Encyclopedia. Retrieved January 29, 2014, from

http://en.wikipedia.org/wiki/William_Osler. Parsons, T. (1951). The social

system. London: Routledge.

Pelling, M. and Webster, C. (1979). “Medical practitioners.” In Webster C (ed.)

(1979) Health, medicine and mortality in the sixteenth century. Cambridge:

Cambridge University Press. pp. 165-235.

Pitkin, D.,K, Hays R.D, McCaffrey D.F, Baker D.W (2001). Does physician gender

affect satisfaction of men and women visiting the emergency department?

Journal of General Internal Medicine. 2001;16:218-226.

Porter, R. (1997). The greatest benefit to mankind. A medical history of humanity

from antiquity to the present. London: Harper Collins Publishers.

Rivett, G. (1997). From cradle to grave. Fifty years of the NHS. London: King’s

Fund. 264.

Robert, C. and Sayers, P. (1987) ‘Keeping the gate’: how judgments are made in inter-

ethnic communication. In Knapp et al. 1987.

Roberts, C., Davies, E., and Jupp, T. (1992). Language and Discrimination: A Study of

Communication in Inter-Ethnic Workplaces. London: Longman.

Roberts, C., and Sarangi, S. (1999). Hybridity in gatekeeping discourse: Issues of

practical relevance for the researcher. In S. Sarangi and C. Roberts (Eds.), Talk,

Work and Institutional Order Discourse in Medical, Mediation and Management

Settings (pp. 473-503). Berlin and New York: Mouton de Gruyter.

Roberts, C. (2001). 'Critical' social theory: Good to think with or something more? In N.

Coupland, S. Sarangi and C. N. Candlin (Eds.), Sociolinguistics and Social

Theory (pp. 1-26). Harlow, England: Pearson Education.

Robson, C. (1993). Real world research: a resource for social scientists and practitioner-

researchers. Oxford: Blackwell.

Roloff, M. E. (1981). Interpersonal communication: The social exchange approach.

Beverly Hills, CA: Sage Publications.

Saunders, M., Lewis, P. & Thornhill, A. (2009) Research Methods For Business

Students, 5th ed., Harlow, Pearson Education.

Sarangi, S. and Roberts, C. (eds) (1999) Talk, Work and Institutional Order: discourse in

medical, mediation and management settings. Berlin: Mouton de Gruyter.

Saunders, M., Lewis, P., and Thornhill, A. (2007). Research methods for business

students (4th edition) Harlow: Pearson Education.

Saville-Troike, Muriel (2003). The Ethnography of Communication: An Introduction

(3rd edition). Language in Society. Blackwell Publishing Announced at

http://linguistlist.org/issues/14/14-917.html.

Schiffrin, D. (1994a) Approaches to Discourse. Oxford: Blackwell. 1994b “Making a

list”. Discourse Processes 17(3), 377- 405.

Schouten, B.C., & Meeuwesen, L. (2006). Cultural Differences in Medical

Communication: A review of the literature. Patient Education and Counseling,

64: 21-34.

Schyve P.M. (2007). Language Differences as a Barrier to Quality and Safety in Health

Care: The Joint Commission Perspective. Journal of General Internal Medicine.

2007 November; 22(Suppl 2): 360–361.

Seijo R, Gomez J, Freidenberg J (1991). Language as a communication barrier in

medical care for Hispanic patients. Hispanic Journal of Behavioral Sciences.

1991;13(4):363-375.

Sekaran, U. (2003). Research Methods For Business (4th ed.). Hoboken, NJ: John Wiley

& Sons.

Sharma, B.K. (Oct 7 2001). Trust is the Basis of Doctor-Patient Relationship. Retrieved

April 11, 2008, from http://www.tribuneindia.com/2001/20011007/

spectrum/fitness.htm

Simmons, M. (1998). Language maintenance and shift in Barcelona: Changing abilities

and uses of Catalan and Castilian. Comparative Culture: The Journal of Miyazaki

International College, 4, pp. 77-93.

Tannen, D. (1999). The argument culture: stopping America’s war of words. New

York: Random House.

Ting-Toomy, S. (1999). Communicating Across Cultures. The Guilford Press, New York,

London.

Tonkin, H., & Reagan, T. (ed. 2003). Language in the Twenty-first Century. Amsterdam:

Benjamins.

Waitzkin H. Doctor-Patient Communication: Clinical Implications of Social Scientific

Research. JAMA. 1984;252 (17):2441-2446.

Weiss, G., and Wodak, R. (Eds.). (2003). Critical Discourse Analysis: Theory and

Interdisciplinary. Basingstoke: Palgrave Macmillan.

Woloshin S., Schwartz L.M., Katz S.J. & Welch H.G. (1997). Is language a barrier to the

use of preventive services? Journal of General Internal Medicine. 12, 472-477.

http://www.tribuneindia.com/2001/20011007/

Working Party of the Royal College of Physicians. (Nov-Dec 2005). Doctors in

Society: Medical Professionalism in a Changing World. Journal of

Clinical Medicine, 5(6 Suppl 1): S5-40.

World Health Organization (2010). William, N., Howard, B. and Joseph, K. (1992).

Hospital Economics and Financing in Developing Countries. WHO, P.34.

i

Appendix-A

QUESTIONNAIRE FOR DOCTORS

Dear Doctor

I am conducting research on the topic entitled, “Communication Barriers in Medical

Settings; A Sociolinguistic Analysis of Doctor-Patient Medical Discourse.” The

purpose of this research is to analyze the doctor–patient medical discourse for effective

healthcare system in Pakistan. Your kind cooperation will help me in drawing conclusions

about the present status of doctor-patient communication in government hospitals at

Rawalpindi and Islamabad. You are requested to fill in the questionnaire. It is assured that

information obtained through this questionnaire will be kept confidential and be used for

the academic purpose only. Your information in this regard is highly valued and would

certainly help to address our academic issues rightly. Please answer as openly and honestly

as possible.

In case of any queries regarding the questionnaire, you are welcome to contact me any

time.

Best regards,

Ejaz Mirza

PhD Scholar in Linguistics

372-PhD/Ling/Jan10-07

NUML, Islamabad.

Cell: 0331-5238555

Email: [email protected]

Note:

This questionnaire has been divided into four parts. Part-A includes demographic

information about doctors. Part-B contains such statements which reflect the

linguistics barriers in doctor–patient medical discourse. Part-C contains social factors

which become hindrance in communication between doctor and patient. Part-D

contains open ended questions for doctors’ opinion to improve their relationship and

reduce miscommunication with patients.

ii

Part-A: Demographic Information

A. Name: ______________________________________________(optional)

B. Hospital’s Name : ____________________________________________

C. Sex: 1. Male 2. Female

D. Age: 1. 21-25 2. 26-30 3. 31-35 4. More than 35Years

E. Marital Status: 1. Single 2. Married

F. Qualification :

_______________________________________________________

G. Specialization :

_______________________________________________________

H. Professional Experience:

1. 01-05 2. 06-10 3. 11-15 4. More than 16Years

I. Job Designation :

______________________________________________________

1. Permanent/ regular 2. Contract 3. Visiting 4. Other

iii

Part-B: Linguistic Factors

Instructions: Please read each statement carefully and encircle your response to each

statement as per scale mentioned below:

Scale: (1= Strongly Agree, 2 = Agree, 3 = Uncertain, 4= Disagree, 5 = Strongly

Disagree)

Linguistic Factors

affecting

communication

Statements Response/Scale

1. Language i s the predominant i n s t r u m e n t

by which information is transmitted between

doctors and patients.

1 2 3 4 5

2. Doctors should have the ability to communicate

in various languages. 1 2 3 4 5

3. Doctors' choice of words affects communication

skills.

1 2 3 4 5

4. Doctors should explain information about disease

and medicine to their patients in detail. 1 2 3 4 5

1. Language 5. Language barriers are faced by doctors in

communicating with patients. 1 2 3 4 5

6. Language barriers occur when people do not

speak the same language. 1 2 3 4 5

7. Language barriers reduce patient’s abilities to

follow instructions and adhere to treatments. 1 2 3 4 5

8. Language differences can create an obstacle to

effective interaction between doctors and patients. 1 2 3 4 5

9. Using visuals (photographs, drawings, diagrams)

can help to overcome language barriers. 1 2 3 4 5

10. Non verbal expressions also contribute to

effective communication. 1 2 3 4 5

11. Doctors’ training in communication skills should

be mandatory for medical profession. 1 2 3 4 5

12. Doctors' training in communication affects

doctor-patient communication. 1 2 3 4 5

13. Successful medical encounters require effective

communication skills between the patient and the

doctor.

1 2 3 4 5

14. Non opening of the discussion is due to lack of

communication training. 1 2 3 4 5

2. Doctors’ training

in communication

15. Gathering and sharing information ability is due to


iv

16. Understanding the patient's perspective is due to


17. Provision of closure in interaction is due to


18. The spoken language is the most important

tool of communication in m e d i c i n e .

1 2 3 4 5

19. The accent of speech used by the doctor also

affects the patient's comprehension of the doctor’s

communication.

1 2 3 4 5

3. Speaking

Proficiency

20. Patients often have trouble in understanding

doctors because he/she speaks too fast. 1 2 3 4 5

21. Verbal expression (tone, pitch) of patient effects

decision of continuing the communication. 1 2 3 4 5

22. The quality of doctors’ voice is also important

for clear communication.

1 2 3 4 5

23. Listening attentively creates a partnership

between doctor and patient. 1 2 3 4 5

24. Doctor’s disinclination to listen to the patient

affects the quality of doctor-patient communication. 1 2 3 4 5

4. Listening

Comprehension

25. Preoccupations such as eating, drinking or doing

handiwork divide attention which mars the listening. 1 2 3 4 5

26. Poor hearing of patients is a barrier to effective

listening for doctors. 1 2 3 4 5

27. The medical terminology used by doctors act as

a barrier in doctor-patient communication. 1 2 3 4 5

28. Patients often fail to understand the meaning of

jargon. 1 2 3 4 5

5. Jargon/Medical

terminology

29. Jargon acts as harmful indicator for medical

treatment of a patient.

1 2 3 4 5

30. The medical terminology creates

miscommunication if used frequently. 1 2 3 4 5

v

Part-C: Social Factors

Social Factors

affecting

communication

Statements

Response/Scale

31. Gender affects communication between doctor and

patient.

1 2 3 4 5

32. Female doctors are more caring and facilitate more

dialogue between the patient and the doctor. 1 2 3 4 5

6. Gender 33. Female doctors prefer a more personal, close setting

for communicating.

1 2 3 4 5

34. Female patients ask more questions than male patients. 1 2 3 4 5

35. Male doctors spend more time in interviewing female

patients than male patients. 1 2 3 4 5

36. Doctors don't communicate well due to their

personality. 1 2 3 4 5

37. Doctors need to be more kind, gentle, considerate,

courteous, and respectful to patients. 1 2 3 4 5

7. Personality

38. Doctors scold their patient during

treatment/counseling. 1 2 3 4 5

39. Negative attitude (rudeness, arrogance) of patient

is a big hurdle in effective communication. 1 2 3 4 5

40. Greeting by the doctors makes patient feel

comfortable. 1 2 3 4 5

41. Doctors encourage patients to ask questions. 1 2 3 4 5

42. The noisy environment makes communication

difficult. 1 2 3 4 5

43. The compatibility of setting (temperature, seating

arrangement, surrounding audience) is a significant

factor in communication.

1 2 3 4 5

8. Location and

Setting

44. Comfortable and relax location promote

communication between doctor and patient. 1 2 3 4 5

45. The level of privacy afford by the setting in which

the doctor-patient interaction occurs also affect doctor-

patient communication.

1 2 3 4 5

46. The doctor’s contact time with patients affect

communication. 1 2 3 4 5

47. Communicative style of the doctor (whether positive or

negative) was not affected by the length of the interaction. 1 2 3 4 5

9. Time 48. The length of time available for the consultation affects

the nature of the discussion. 1 2 3 4 5

49. Waiting time for physical examination is long for

patients which affect their communication. 1 2 3 4 5

vi

50. Doctors get enough time for each individual

patient as far as examination is concerned. 1 2 3 4 5

51. The level of education of patient is prominent

factor in effective communication. 1 2 3 4 5

52. Low health literacy of the patient affects

communication. 1 2 3 4 5

10. Education 53. Doctors feel uncomfortable while communicating

with a patient whose intellectual level is lower. 1 2 3 4 5

54. Patients' ability to explain their conditions

(complaints and symptoms) to the doctor is a factor that

also impacts the quality of doctor-patient

communication.

1 2 3 4 5

55. Doctors should try to communicate at the hearer’s level

of conceptualization to ensure understanding by the patient. 1 2 3 4 5

D. OPEN ENDED QUESTIONS

1. What do you think could be done to improve doctor-patient medical

discourse?

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

2. What do you think could be done to reduce miscommunication between doctor-

patient?

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

Thank you so much!!!

vii

Appendix-B

INTERVIEW QUESTIONS FOR PATIENTS

Q.1 How do you see language as communication barrier in government hospitals of

district Rawalpindi?

Q.2 Do you think that the training in communication skills for the doctors can be

useful to improve doctor-patient interaction?

Q.3 How far do you think that the patients feel threatened by the doctor’s personality

in government hospitals of district Rawalpindi?

Q. 4 What would you say about the speaking and listening skills of doctors towards

patients?

Q.5 How far the jargon and medical terminology creating miscommunication between

doctor and patient?

Q.6 What are your views about the location and setting during doctor-patient

consultation?

Q.7 Do you agree that the doctors’ gender effect in doctor-patient interaction?

Q.8 How far the time (duration of consultation) is important for doctor-patient

communication?

communication barriers in medical setting: a...

Documents