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.

This article summarizes the results of 41 independent studies containing correlates of objectively measured provider behaviors in medical encounters. Provider behaviors were grouped a priori into the process categories of information giving, questions, competence, partnership building, and socioemotional behavior. Total amount of communication was also included. All correlations between variables within these categories and external variables (patient outcome variables or patient and provider background variables) were extracted. The most frequently occurring outcome variables were satisfaction, recall, and compliance, and the most frequently occurring background variables were the patient's gender, age, and social class. Average correlations and combined significance levels were calculated for each combination of process category and external variable. Results showed significant relations of small to moderate average magnitude between these external variables and almost all of the provider behavior categories. A theory of provider-patient reciprocation is proposed to account for the pattern of results.

Meta-analysis of correlates of provider behavior in medical encounters.

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

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

Doctor-patient interactions were tape-recorded and coded according to a modified system of Interaction Process Analysis. These data, combined with a series of patient interviews and a self-administered questionnaire completed by physicians, were analyzed to determine the extent of patient compliance with doctors' orders and how variations in patient compliance are influenced by some selected patient characteristics and by the structure and process of the doctor-patient relationship.None of the demographic characteristics of patients investigated here was associated with compliance. However, the ways in which doctors and patients initially fit their activity into the presumably institutionalized patterns of behavior appropriate for doctor-patient interaction and the way they deviate over time from the institutionalized role expectations was found to be related to variations in patient compliance.

Variation in patients' compliance with doctors' orders: medical practice and doctor-patient interaction.

Physician's orientation toward the legitimacy of drug use and their preferred source of new drug information☆

In medical sociology, there is a well-documented concept called "illness behavior" which states that symptoms of illness are differentially perceived, evaluated, and acted upon by different kinds of people in different social situations (Mechanic, 1962). A number of measures of illness behavior such as responses to pain, recognition of symptoms, attitudes toward illness, utilization of health facilities, and compliance with medical advice have been demonstrated to be significantly related to social and cultural factors such as age, sex, social class, anfd ethnic background. Also, measures of illness behavior are related to medical criteria such as the number of physical or psychological problems or to such environmental factors as the degree of stress, social participation, or social integration into the community. Since the use of drugs also can be viewed as a means of acting upon recognized symptoms, the purpose of the present study will be: (a) to define the prevalence of psychotherapeutic drug use within a sample population, and (b) to analyse use in terms of social, cultural, medical, and environmental factors. Although there have been statistical reports indicating increases in the production and marketing of mood-altering drugs and evidence that patients are placing increasing pressure on their physicians to prescribe them (Greenlick, 1967), few studies of drug use in normal populations have been reported.

https://www.jstor.org/stable/pdfplus/2137077.pdf

Milton S. Davis

Papers

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

Variation in patients' compliance with doctors' orders: medical practice and doctor-patient interaction.

Physician's orientation toward the legitimacy of drug use and their preferred source of new drug information☆

The use of psychotherapeutic drugs by middle-aged women.

Factors associated with actual and preferred activities of pharmacists.