Doctor-patient communication.

Over the past 5 years the research team at the Childrens Hospital of Los Angeles has been investigating the problem of doctor-patient communication a crucial but neglected aspect of medical care. Medical schools continue to leave the learning of the "art" of medical practice to the individuals own initiative and intuition which is a serious omission. The emergency clinic of the Childrens Hospital satisfied the objective of a setting that would enable the team to examine selectively the doctor-patient communication process itself. Children are brought to this walk-in clinic with a great variety of acute illnesses or accidental injuries invariably accompanied by a parent. The visit usually is short and generally yields a specific recommendation from the doctor to the parent. The clinic has a large staff of pediatricians mostly young well-trained full-time residents. In basic study 800 visits by 800 different patients were observed. As the interaction was primarily between the childs mother and the doctor the mother was designated as "the patient." The standard procedure was to make an audio tape recording of the entire interview then question the mother immediately afterward concerning what she had expected from the visit and her reactions to it. A follow-up was conducted within 14 days to learn whether or not the mother had complied with the doctors instructions. Of the entire group 40% were highly satisfied 36% moderately satisfied 11% moderately dissatisfied and 13% highly dissatisfied. The fact that 76% of these anxious mothers were more or less satisfied with the doctors performance in their brief encounter in the clinic was reassuring. Their specific reactions were less favorable. Nearly 1/5 149 mothers felt they had not received a clear statement of what was wrong with their baby; almost half of the entire group were still wondering when they left the physician what had caused their childs illness. 42% of the mothers had carried out all of the doctors medical advice 38% had complied only in part and 11% not at all. A substantial correlation was found between the mothers expressed satisfaction with the doctors behavior in the visit and their compliance with his instruction. The general impression that physicians tend to be too technical in language for their patients was confirmed strongly by the study. The most severe and most common complaint of the dissatisfied mothers was that the physician had shown too little interest in their great concern about their child.