Key questions--a strategy for modifying clinical communication. Transforming tacit skills into a clinical method.

BACKGROUND: A clinical communicative method designed to promote the doctor's understanding of women's "undefined" disorders is presented and discussed. The method is composed of key questions, which are problem-oriented speech acts, inviting the patient to share with the doctor her conception of illness. The questions are directed towards specific clinical problems, and are not meant as global devices for better doctor-patient communication in general. PROCEDURE: The clinical method is the outcome of a procedure where key questions are systematically developed. The procedure starts with individual successful communicative experiences and moves towards questions that are applicable towards various patients presenting the actual clinical problem. The procedure is described qualitatively, and delivers cues from which the modes of asking can be adjusted and employed by other doctors. OUTCOMES: The procedure consists of these steps: 1) declaring the clinical problem for investigation, 2) specifying a relevant communicative intention, 3) assigning fertile themes of knowledge, 4) identifying an efficacious utterance for further refinement, and 5) expanding the validity of the utterance.
CONCLUSION: By making visible, systematizing and refining the doctor's tacit conversational skills, the clinical method represents a model for transforming individual clinical experiences into medical knowledge. Premises for generalization of the method towards clinical problems beyond women's "undefined" disorders are discussed.