A study of doctors' and patients' communication during a primary care consultation: implications for communication training.

Previous coding schemes used to assess doctor-patient interaction have been inadequate with respect to the scope of categories used to identify: (a) information exchange and relational communication, and (b) thematic topics of talk. Thirty-two doctor-patient interviews were analyzed with a new coding scheme that includes multiple categories of information exchange and relational communication, and allows for identification of thematic topics of talk. The results revealed both effective and less effective patterns of information exchange and relational communication between doctors and patients. These patterns were further elaborated by examining the topics of talk with which they occurred. Particular attention was given to implications the results have for communication skills training for doctors and patients.

[1]  D. Steele,et al.  Have you been taking your pills? The adherence-monitoring sequence in the medical interview. , 1990, The Journal of family practice.

[2]  H. Waitzkin,et al.  On Studying the Discourse of Medical Encounters: A Critique of Quantitative and Qualitative Methods and a Proposal for Reasonable Compromise , 1990, Medical care.

[3]  H. Waitzkin,et al.  Doctor-patient communication. Clinical implications of social scientific research. , 1984, JAMA.

[4]  R. Adelman,et al.  Physician and Older Patient Support in the Medical Encounter , 1996 .

[5]  J. Bensing Doctor-patient communication and the quality of care. , 1991, Social science & medicine.

[6]  D. Cegala,et al.  A Study of Doctors' and Patients' Perceptions of Information Processing and Communication Competence During the Medical Interview , 1995 .

[7]  J. Dale,et al.  Patient expectations: what do primary care patients want from the GP and how far does meeting expectations affect patient satisfaction? , 1995, Family practice.

[8]  D. Cegala,et al.  Components of Patients' and Doctors' Perceptions of Communication Competence During a Primary Care Medical Interview , 1996 .

[9]  M. Dimatteo,et al.  Enhancing Medication Adherence Through Communication and Informed Collaborative Choice , 1994 .

[10]  W. Kukull,et al.  Outcome-Based Doctor-Patient Interaction Analysis: II. Identifying Effective Provider and Patient Behavior , 1982, Medical care.

[11]  R. Street Physicians' communication and parents' evaluations of pediatric consultations. , 1991, Medical care.

[12]  D. Roter Patient question asking in physician-patient interaction. , 1984, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[13]  W. Stiles The process‐outcome correlation problem and the uses of verbal interaction process coding , 1993 .

[14]  H. Waitzkin,et al.  A Critical Theory of Medical Discourse: How Patients and Health Professionals Deal with Social Problems , 1989, International journal of health services : planning, administration, evaluation.

[15]  D. Buller,et al.  The role of perceived affect and information in patients’ evaluations of health care and compliance decisions , 1991 .

[16]  M. Crouch,et al.  Interviewing style and response to family information by family practice residents. , 1986, Family medicine.

[17]  Richard Frankel,et al.  Miscommunication in medicine , 1991 .

[18]  Judith A. Hall,et al.  Meta-analysis of satisfaction with medical care: description of research domain and analysis of overall satisfaction levels. , 1988, Social science & medicine.

[19]  J. Kirscht,et al.  Understanding and improving patient compliance. , 1984, Annals of internal medicine.

[20]  A. Todd,et al.  The prescription of contraception: Negotiations between doctors and patients , 1984 .

[21]  Deborah S. Ballard-Reisch A Model of Participative Decision Making for Physician-Patient Interaction , 1990 .

[22]  D. Roter,et al.  Quantitative and qualitative approaches to the evaluation of the medical dialogue. , 1992, Social science & medicine.

[23]  E. Rich,et al.  Attitudes of internal medicine residents and staff physicians toward various patient characteristics. , 1985, Journal of medical education.

[24]  A. Suchman,et al.  What makes the patient-doctor relationship therapeutic? Exploring the connexional dimension of medical care. , 1988, Annals of internal medicine.

[25]  R. Street Analyzing messages and their outcomes: Questionable assumptions, possible solutions , 1993 .

[26]  Lorraine D. Jackson,et al.  Information Complexity and Medical Communication: The Effects of Technical Language and Amount of Information in a Medical Message , 1992 .

[27]  R. Parrott Exploring family Practitioners' and Patients' Information Exchange About Prescribed Medications: Implications for Practitioners' Interviewing and Patients' Understanding , 1994 .

[28]  D. Roter,et al.  Health education theory: an application to the process of patient-provider communication. , 1991, Health education research.

[29]  D. Tuckett,et al.  A new approach to the measurement of patients' understanding of what they are told in medical consultations. , 1985, Journal of health and social behavior.

[30]  D. Tuckett,et al.  Approaches to the measurement of explanation and information-giving in medical consultations: a review of empirical studies. , 1984, Social science & medicine.

[31]  C. Sherbourne,et al.  Adherence to cancer regimens: implications for treating the older patient. , 1992, Oncology.

[32]  K. Rost,et al.  Introduction of information during the initial medical visit: consequences for patient follow-through with physician recommendations for medication. , 1989, Social science & medicine.

[33]  A. Beisecker,et al.  Patient Information-Seeking Behaviors When Communicating With Doctors , 1990, Medical care.

[34]  J. Mathews,et al.  The communication process in clinical settings. , 1983, Social science & medicine.

[35]  H. Waitzkin Information giving in medical care. , 1985, Journal of health and social behavior.

[36]  L. Anderson,et al.  Improving patient and provider communication: A synthesis and review of communication interventions , 1991 .

[37]  A. Beisecker,et al.  Patient Power in Doctor-Patient Communication: What Do We Know? , 1990 .

[38]  Gary L. Kreps Relational communication in health care , 1988 .

[39]  R Charon,et al.  Multi-dimensional interaction analysis: a collaborative approach to the study of medical discourse. , 1994, Social science & medicine.

[40]  T. Quill,et al.  Recognizing and adjusting to barriers in doctor-patient communication. , 1989, Annals of internal medicine.

[41]  B. Lambert,et al.  Communication About Medications: Directions for Research , 1994 .

[42]  C. S. Beck,et al.  Enabling Patients and Physicians to Pursue Multiple Goals in Health Care Encounters: A Case Study , 1996 .

[43]  Judith A. Hall,et al.  Patient-physician communication: A descriptive summary of the literature , 1988 .

[44]  L. Frederikson,et al.  Development of an Integrative Model for Medical Consultation , 1993 .

[45]  J. de Haes,et al.  Doctor-patient communication: a review of the literature. , 1995, Social science & medicine.

[46]  K. Bertakis The communication of information from physician to patient: a method for increasing patient retention and satisfaction. , 1977, The Journal of family practice.