Mental models, medical misunderstandings, and expressive and instrumental behaviour

By Gordon Rugg

A frequent and enduring topic of complaints about medical professionals is their bedside manner.

Three common complaints are:

  • My doctor won’t listen to me
  • My doctor is cold and impersonal
  • My doctor doesn’t give me the facts

These can be explained and handled via the concepts of instrumental and expressive behaviour. Instrumental behaviour is about getting the job done; expressive behaviour is about showing how you feel about something. I’ve blogged about these concepts and their implications here and here and here.

These categories are not mutually exclusive; some people are very strong both on instrumental and on expressive behaviour, for instance. However, people tend to incline more to one than the other. The “people person” with good social skills is typically good on expressive behaviour, while the archetypal “techie” is strong on instrumental behaviour.

The issue of expressive versus instrumental behaviour is a common cause of serious misunderstandings across many domains; medicine is a classic case. Fortunately, many of these misunderstandings can be fairly easily prevented. In this article, I’ll describe the underlying concepts, and how to use them to reduce the number and severity of complaints.

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