How do GPs, Nurse and Pharmacist Prescribers Manage Patients’ Emotional Cues and Concerns in Healthcare Encounters?

  • Ruth Riley

Student thesis: Doctoral ThesisPhD


In healthcare encounters, patients communicate wide-ranging concerns relating to their health and illness experience, treatment or wider psychosocial world. This research draws upon a normative understanding of patient centred approaches which recognise the clinical and psychotherapeutic value in having the opportunity to talk to someone who will listen empathetically and to have expressed concerns acknowledged and understood.The aim of this research was to understand how GPs, nurse and pharmacist prescribers manage patients’ emotional cues and concerns in healthcare encounters. This research employed a mixed method study underpinned by an interpretative epistemology to understand, in particular, how nurse and pharmacists as ‘new prescribers’ manage emotionality during consultations in primary care. The study also critically reflected on the value and limitations of the study methodology to explore this topic. Phase one employed a coding framework to code 528 consultations with 20 GPs, 19 nurses and 12 pharmacist prescribers. The nature and content of patients’ cues and concerns and healthcare professionals’ responses were coded and analysed quantitatively. Phase two undertook qualitative analysis on a sub-sample of 30 transcribed recordings to understand barriers and facilitators to offering emotional labour during the consultation process. Phase one found that patients communicate on average 3.4 cues and concerns per consultation and of those concerns expressed, half related to biomedical concerns. Other cue and concern types related to medication, the impact of a patient’s condition/symptoms on their day-to-day life and cues and concerns related to psychosocial issues, including job stress, family problems, or bereavement. Phase one found that there were significant differences between the type of positive/missed responses to patients’ cues and concerns across the groups. 81% of pharmacists’ responses were coded as positive compared with 72% of nurse prescriber responses and 52% of GP responses. Male GPs were significantly more likely to miss patients’ cues and concerns compared to female GPs. Phase two drew upon emotion work theory and models of patient centred care to identify the ways in which emotions are communicated and managed within healthcare encounters recorded for this study. Phase two identified facilitators (such as attuning to the patient’s world, evidence of listening, providing space, validating and legitimising patients’ concerns) and barriers (emotional disengagement, task focused and structured/agenda driven consultations) to the employment of emotional labour. These findings identify that a complex inter-play of individual, socio-cultural and political factors have potential to influence the way in which emotionality is managed during the consultation process. The findings reinforce the importance of patient centred approaches and communication skills training and the need for support, supervision and training to enable healthcare professionals to manage their emotionality and that of their patients.
Date of Award24 Jul 2014
Original languageEnglish
Awarding Institution
  • University of Bath
SupervisorMarjorie Weiss (Supervisor)


  • patient centred care
  • emotional labour
  • primary care
  • empathy
  • nurses
  • pharmacists
  • general practitioners

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