Patients' medical knowledge and health counseling: What kind of information helps to make communication patient-centered?

Objective: To examine how physicians use information about a patient's background knowledge when both anticipating what a patient knows and producing actual answers in an email counseling setting. Methods: A fictitious patient used a (high vs. low) level of technical jargon in an email inquiry about diabetes and provided explicit information on prior knowledge (high vs. low) through self-report. Final-year medical students (semi-experts) were asked to gauge the patient's knowledge level (Experiment 1) and to produce an answer to the inquiry (Experiment 2). A total of N = 150 participated in one of the two experiments. Results: Information from word usage and self-reports was used differently in the two experiments. A patient self-reporting low knowledge was assumed to have less background knowledge than one reporting some knowledge about the domain. The technicality of the patient's word use influenced the answers: these were more technical when the inquiry used technical jargon instead of everyday language. Conclusion: Knowledge anticipation and communication behavior in email health care seem to be guided by different hints regarding the patient, suggesting the existence of two separate mechanisms. Practice implications: Beyond merely teaching physicians or health care providers to be aware of the patient's knowledge level when formulating a patient-centered response, on-task methods should support health care providers during the actual communication phase by providing, for instance, metacognitive prompts. (C) 2012 Elsevier Ireland Ltd. All rights reserved.