https://in.bgu.ac.il/en/fohs/communityhealth/Family/Documents/DOCTOR-PATIENT%20COMMUNICATION%20A%20REVIEW%20OF.pdf

Doctor-patient communication: a review of the literature.

An intervention was developed to increase patient involvement in care. Using a treatment algorithm as a guide, patients were helped to read their medical record and coached to ask questions and negotiate medical decisions with their physicians during a 20-minute session before their regularly scheduled visit. In a randomized controlled trial we compared this intervention with a standard educational session of equal length in a clinic for patients with ulcer disease. Six to eight weeks after the trial, patients in the experimental group reported fewer limitations in physical and role-related activities (p less than 0.05), preferred a more active role in medical decision-making, and were as satisfied with their care as the control group. Analysis of audiotapes of physician-patient interactions showed that patients in the experimental group were twice as effective as control patients in obtaining information from physicians (p less than 0.05). Results of the intervention included increased involvement in the interaction with the physician, fewer limitations imposed by the disease on patients' functional ability, and increased preference for active involvement in medical decision-making.

Expanding patient involvement in care. Effects on patient outcomes.

The influence of physicians' attributes and practice style on patients' adherence to treatment was examined in a 2-year longitudinal study of 186 physicians and their diabetes, hypertension, and heart disease patients. A physician-level analysis was conducted, controlling for baseline patient adherence rates and for patient characteristics predictive of adherence in previous analyses. General adherence and adherence to medication, exercise, and diet recommendations were examined. Baseline adherence rates were associated with adherence rates 2 years later. Other predictors were physician job satisfaction (general adherence), number of patients seen per week (medication), scheduling a follow-up appointment (medication), tendency to answer patients' questions (exercise), number of tests ordered (diet), seriousness of illness (diet), physician specialty (medication, diet), and patient health distress (medication, exercise).

Physicians' characteristics influence patients' adherence to medical treatment: Results from the Medical Outcomes Study.

Physicians' Characteristics Influence Patients' Adherence to Medical Treatment

The purpose of this study was to investigate the effectiveness, dynamics, and consequences of a health education intervention designed to increase patient question asking during the patient's medical visit Data were collected at a Baltimore family and community health center which provides outpatient services to a low income, predominantly black and female population The majority of the study participants were, in addition, elderly and chronically ill A total of 294 patients and 3 providers took part in the study The study design included random assignment of patients to experimental and placebo groups with two non-equivalent (non-randomized) control groups Findings included: (1) The experimental group patients asked more direct questions and fewer indirect questions than did placebo group patients (2) The experimental group patient-provider interaction was characterized by negative affect, anxiety, and anger, while the placebo group patient-provider interaction was characterized as mutually sympathetic (3) The experimental group patients were less satisfied with care received in the clinic on the day of their visit than were placebo patients (4) The experimental group patients demonstrated higher appointment-keeping ratios (an average number of appointments kept divided by an average number of appointments made) during a four-month prospective monitoring period

Patient Participation in the Patient-Provider Interaction: The Effects of Patient Question Asking on the Quality of Interaction, Satisfaction and Compliance*

Extract: As one of several approaches to scientific analysis of doctor-patient communication 285 visits to a pediatric walk-in clinic were scrutinized using an expanded version of Bales' Interaction Process Analysis Data analysis consisted of individual case studies and computer programs for descriptive summaries of cases and index scores. Factor analysis and chi-square calculations were among the methods used to test significant relations between attributes of the doctor-patient interaction and the dependent variables, patient satisfaction, compliance, and demography. As hypothesized, a distinctive behavior pattern emerged for doctor, parent, and child. Doctors were found to talk more but show less emotion than mothers. Almost two-thirds of the mother's communication related to medical history, while the doctor discussed history and treatment but gave little reassurance or friendlines to the mother, almost half of his conversation with the child consisited of friendly statements. In general, outcome of the medical consultation was found to be favourably influenced by having physician who was friendly, expressed solidarity, took some time to discuss nonmedical, social subjects, and gave the impression of offering information freely without the patients having to request it or feeling excessively questioned. Speculation: Because of the complicated nature and limited methods available for study, the doctor-patient relation has rarely been subjected to scientific inquiry or attempts at quantification. It is hoped that the present effort as well as other ongoing studies will contribute to a body of scientific information which in itself may have application for pediatric education and practice and which ultimately might contribute one approach in urgently needed studies of the quality of medical care.

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Barbara Fremon

Papers

Gaps in Doctor-Patient Communication: Doctor-Patient Interaction Analysis