Conferences

The communication between a professional and a patient is more complicated than was thought until now in the medical profession. The social aspect of the communication, most of the time not well included in the medical education and sometimes viewed as an obstacle, is nowadays accepted as a component that can facilitate the medical diagnosis. Research done in the GP practice (Bensing 2003) shows how it works. From video observations it became clear that the process to come to an adequate diagnosis depends on the communication skills, both on the GP as well on the patient. Moreover when looking at an ongoing clinical communication process it is evident that different components of the communication do not emerge as simple functions of the participants. Instead the emerging pattern is constantly influenced by the preceding communication. It is a matter of feedback between the two actors of the process, and the interaction of psychic components in the actors themselves that also can be described as (inner) feedback. Those processes can be simulated in continuous simulation models that are described with differential equations. However simple linear differential equations fail to capture that complexity of patient-provider communication. Non linear differential equations, has to serve as a foundation computer model on patient-provider interaction that takes the ongoing causal relationships between communication elements into account. The possibility that such models show that the communication can becoming chaotic and lead to surprises the GP only can anticipate as a surfer on waves, is nowadays discussed in the medical sciences (Suchman 2006). In earlier simulation studies of the authors the non chaotic dynamics of a model of the communication between the GP and patient, including 2 external feedback loops and 3 internal feedback loops, is reproduced with the aid of simulation software. The results of the simulation are compared with quantitative and qualitative representations of video observations of such communications and showed to be correct at face-value (Dijkum et al 2008).
In this paper the non linear chaotic dynamics of such models is further investigated by using Matlab to simulate the chaotic phases of the model, thereby extending studies of mathematical models of 2 coupled processes (Savi 2007) to 2×3 coupled processes.
With this simulation study the exact character of the communication between the GP and patient can be better understood and used as a pattern recognition technique to facilitate the communication.

References:

Bensing et al (2003). Communication patterns of primary care physicians in the United States and the Netherlands. Journal of General Internal Medicine, 2003;18:335-342.
Savi M., (2007). Effects of randomness on chaos and order of coupled logistic maps. Physics Letters A, 364 (2007) 389–395.
Suchman A., (2006). A new Theoretical foundation for relationship -centered care. Journal of General International Medicine 2006: 21: S40-44.
Dijkum, C. van, Verheul W., Lam N., Bensing J. (2008). Non Linear Models for the Feedback between GP and Patients. In Trappl R. (Ed). Cybernetics and Systems. Vienna: Austrian Society for Cybernetic Studies, pp. 629-634.