The medical consultation viewed as a value chain: A neurobehavioral approach to emotion regulation in doctor-patient interaction

Objective: To present a model of the medical consultation as a value chain, and to apply a neurobehavioral perspective to analyze each element in the chain with relevance for emotion regulation. Methods: Current knowledge on four elements in medical consultations and neuroscientific evidence on corresponding basic processes are selectively reviewed. Results: The four elements of communication behaviours presented as steps in a value chain model are: (1) establishing rapport, (2) patient disclosure of emotional Cues and concerns, (3) the doctor's expression of empathy, and (4) positive reappraisal of concerns. Conclusion: The metaphor of the value chain, with emphasis on goal orientation, helps to understand the impact of each communicative element on the outcome of the consultation. Added value at each step is proposed in terms of effects on outcome indicators; in this case patients affect regulation. Neurobehavioral mechanisms are suggested to explain the association between communication behaviour and affect regulation outcome. Practice implications: The value chain metaphor and the emphasis on behaviour-outcome-mechanisms associations may be of interest as conceptualizations for communications skills training. (C) 2008 Elsevier Ireland Ltd. All rights reserved.