Key encounter 2: an education session with a 'stable' patient

Although both participants have had long-term involvement in renal care a shared understanding was not achieved about key concepts related to biochemical monitoring (blood test results) and management (medication and diet).

Neither participant was aware of the extent of the communication difficulty due to:

• the patient's English conversational competence which masked different understandings of biomedical concepts
• the structure of the interaction which excluded opportunities for different understandings to be revealed

The limited extent of shared understanding only emerged through the comparison and contrast of participants' interpretations of the interaction through interviews and video analysis.

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