What did the doctor say--what did the patient hear? Operational knowledge in clinical communication

OBJECTIVES: We aim to introduce Piaget's concept of 'operational knowledge' from the cognitive theory of learning--as a contribution to the broader understanding of clinical interaction. METHOD: Our study involves a theoretical presentation of different kinds and levels of human understanding, illustrated by a case story in which the difference between operational and figurative knowledge was demonstrated. This study used the case story of a male patient aged 80, who was suffering from ulcerative colitis. We appealed to the reader's perceived relevance of these perspectives, in order to understand what was going on between doctor and patient. RESULTS: The case story demonstrates the phenomenon of operational knowledge in the patient, the close links between communicative action and cognitive understanding, and the importance for the doctor of reflecting upon this level of interaction. CONCLUSION: According to the patient-centred clinical method, the doctor should explore the social and emotional context of the patient in order to understand the meaning of the illness. We suggest that a cognitive dimension should also be added, and that the concept of 'operational knowledge' might be useful for such investigations.