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 broaderunderstanding of clinical interaction. METHOD: Our study involves atheoretical presentation of different kinds and levels of humanunderstanding, illustrated by a case story in which the difference betweenoperational and figurative knowledge was demonstrated. This study used thecase story of a male patient aged 80, who was suffering from ulcerativecolitis. We appealed to the reader's perceived relevance of theseperspectives, in order to understand what was going on between doctor andpatient. RESULTS: The case story demonstrates the phenomenon of operationalknowledge in the patient, the close links between communicative action andcognitive understanding, and the importance for the doctor of reflectingupon this level of interaction. CONCLUSION: According to thepatient-centred clinical method, the doctor should explore the social andemotional context of the patient in order to understand the meaning of theillness. We suggest that a cognitive dimension should also be added, andthat the concept of 'operational knowledge' might be useful for suchinvestigations.