Interruption and rapport disruption: measuring the prevalence and nature of verbal interruptions during back pain consultations

ABSTRACT

Background: Evaluating the impact of communication during clinical encounters is complex. One behaviour, largely ignored in clinical practice and training, is interruptions in verbal communication. Two types exist: an ‘overlap’ (an error projecting when a turn ends); and an ‘interruption’ (when an individual starts talking before the speaker's turn is complete). This paper reports the prevalence of these behaviours during initial consultations involving physiotherapists and patients with back pain.

Method: 25 initial back pain consultations were observed, audio-recorded, transcribed verbatim, analysed thematically and managed using a Framework approach.

Results: The data set comprised 15,489 turns: 7659 by patients; 7647 by clinicians; and 183 by others (patients’ spouse or clinical colleagues). Clinicians were 7 times more likely to interrupt than patients (284 and 39 respectively), however overlaps were 1.5 times more prevalent among patients (n = 582) compared to clinicians (n = 385). The main functions for interruptions by clinicians and patients were to ‘seek’ or ‘give’ additional information respectively. A trend was noted that female physiotherapists were 3 times more likely to interrupt than male clinicians and overall, the prevalence of interruptions in same-sex consultations was twice as likely as in mixed-sex encounters, however the small sample size precluded secondary analyses.

Conclusion: Alongside measuring the prevalence of interruptions in back pain consultations, this study identified differences in the nature of interruptions made by physiotherapists and patients. It highlights the complexity of clinical encounters and that being aware of interruptions is important to optimize rapport and clinician-patient relationships.

KEYWORDS:

• Health communication
• interruptions
• interaction
• back pain
• physical therapy
• professional-patient relations

Ethical approval

Ethical approval for this study was granted by the Southampton and South 125 West Hampshire Local Research Ethics Committee (08/H0502/15).

Disclosure statement

No potential conflict of interest was reported by the authors.

Acknowledgments

The authors wish to thank: the patients and staff in the former Southampton City Primary Care Trust; Arthritis Research UK for funding the fellowship of the senior researcher (LR) that enabled the original data collection (grant number 17830); and Professors Cyrus Cooper, Paul Little, Maria Stokes, Jennifer Cleland and Mark Mullee and Dr Rose Wiles for their contribution to the original study.

Notes on contributors

Lisa C. Roberts, PhD, is an Associate Professor at the University of Southampton and Consultant Physiotherapist within University Hospital Southampton NHS Foundation Trust. Her research interests include communication skills, clinical decision making and back pain. Lisa is also the immediate past President of the Society for Back Pain Research and is a Fellow of the Chartered Society of Physiotherapy.

Faye A. Burrow was an MSc (Pre-Registration) Physiotherapy student at the University of Southampton at the time of data collection. After starting her physiotherapy career in the UK, Faye has relocated to Australia.

ORCID

Lisa C. Roberts http://orcid.org/0000-0003-2662-6696

Additional information

Funding

No specific funding was sought for this research however the senior researcher (LR) is funded by a National Institute for Health Research Senior Clinical Lectureship (round 3); and Arthritis Research UK funded the original data collection [grant number 17830].