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 knowl edge' from the cognitive theory of learning-as a contribution to the b roader understanding of clinical interaction. Method. Our study involv es a theoretical presentation of different kinds and levels of human u nderstanding, illustrated by a case story in which the difference betw een 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 phenomeno n of operational knowledge in the patient, the close links between com municative action and cognitive understanding, and the importance for the doctor of reflecting upon this level of interaction. Conclusion. A ccording to the patient-centred clinical method, the doctor should exp lore the social and emotional context of the patient in order to under stand the meaning of the illness. We suggest that a cognitive dimensio n should also be added, and that the concept of 'operational knowledge ' might be useful for such investigations.