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The medical consultation viewed as a value chain A neurobehavioral approach to emotion regulation in doctor–patient interaction.pdf

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The medical consultation viewed as a value chain A neurobehavioral approach to emotion regulation in doctor–patient interaction.pdf

Patient Education and Counseling 74 (2009) 323–330 Contents lists available at ScienceDirect Patient Education and Counseling journal homepage: /locate/pateducou The medical consultation viewed as a value chain: A neurobehavioral approach to emotion regulation in doctor–patient interaction§ Arnstein Finset *, Trond A. Mjaaland Department of Behavioural Science in Medicine, University of Oslo, Oslo, Norway ARTICLE INFO Article history: Received 25 July 2008 Received in revised form 25 November 2008 Accepted 5 December 2008 Keywords: Physician patient relations General practice Value chain Neurobiology Neuropsychology Communication skills training ABSTRACT Objective: To present a model of the medical consultation as a value chain, and to apply a neurobehavioral perspective to analyze each element in the chain with relevance for emotion regulation. Methods: Current knowledge on four elements in medical consultations and neuroscienti?c evidence on corresponding basic processes are selectively reviewed. Results: The four elements of communication behaviours presented as steps in a value chain model are: (1) establishing rapport, (2) patient disclosure of emotional cues and concerns, (3) the doctor’s expression of empathy, and (4) positive reappraisal of concerns. Conclusion: The metaphor of the value chain, with emphasis on goal orientation, helps to understand the impact of each communicative element on the outcome of the consultation. Added value at each step is proposed in terms of effects on outcome indicators; in this case patients affect regulation. Neurobehavioral mechanisms are suggested to explain the association between communication behaviour and affect regulation outcome. Practice implications: The value chain metaphor and the emphasis on behaviour–outcome–mechanisms associations may be of interest as conceptualizations for communications skills training. ? 2008 Elsevier Ireland Ltd. All rights reserved. 1. Introduction In this article we discuss the medical