The content of physician/patient communication in family practice.

The verbal communication between physicians and patients was quantified in a total of 556 office visits to 22 general practitioners in Florida. 40% of these visits involved follow-up of chronic health conditions while the remaining 60% were for acute conditions of recent onset. The number of units of expression coded per office visit averaged 40 with the physician contributing 56% of the communication. The content of verbal exchanges focused on medical history taking (22%) patient responses to questions (23%) problem resolution of medical matters (23%) and discussion of social and family matters (11%). At 131 visits (24%) patients did not ask any questions. During interaction on medical matters physicians initiated 80% of the interview; in contrast in discussions of social and family matters patients instigated 70% of the interaction. The units of expression per visit varied by social class being 54.2 for upper class patients and only 32.8 for lower class patients. Patients with chronic health conditions also had a relatively high number of units of expression (49.3) per visit. There were too few cases in this study to make a detailed analysis of differences between individual physicians and their communication patterns; however physicians who acted as preceptors for medical students and residents averaged 42.8 units of expression per patient compared with 31.7 units for nonpreceptors. Overall these findings indicate that the acquisition of facts interpretation of symptoms and signs and formulation of a diagnosis are the major thrusts of physician interaction while patients are frequently more concerned with the impact of illness of social and family situations. Thus attention to psychosocial issues should be given more prominence in family practice.