Reliance on HPs own impressions
To meet patients ‘where they are’, HPs relied on their own impressions of their preferences and needs and not on factual knowledge from the medical records. For example, there were some patients who smelled of urine or smoke, had long nails, puffy skin, or greasy hair or were dressed in dirty, crumpled clothes. When HPs encountered such patients, they tried to pay special attention to them by asking them how they were doing or reminding them of their next appointment. HPs tried not to plan consultations too early in the morning to increase the probability of patients showing up. When patients had poor hygiene, HPs also tried to simplify information:
“If I sense that the patient has social challenges,… then I don’t use technical terms and I don’t go into too much detail. Then I give a general description, and if they have elaborate questions, then I answer them of course” (D3:1).
HPs preferred to use their own impressions in targeting their communication and their information:
”I try to talk with the patient, so it matches how I sense his intellectual level” (D2:1).
Finding out ‘where the patient is’ was also facilitated by listening to the questions patients asked. HPs explained that patients’ questions could reflect their understanding of their illness and treatment. HPs also listened to the patients’ language, to the level of detail and complexity in presenting their problem, and tried to adapt their information accordingly:
“Some patients quote the medical record using the right words. Others just say: I had a spot on my skin with something in it. So, it is about finding out where to start” (D5:1).
We observed that the more detailed the patients’ description of their problems, the more detailed was information they were given. Those patients who arrived with detailed notes about their condition and questions for the HPs, especially those who brought a companion, were given more in-depth information about their illness and treatment than patients who showed up alone and with no visible preparation.