What is a successful doctor-patient interview? a study of interactions and outcomes

https://doi.org/10.1016/0277-9536(84)90284-3Get rights and content

Abstract

The discipline of family medicine has espoused a patient-centered model of the doctor-patient interaction. Patient-centered interactions are those in which the patient's point of view is actively sought by the physician. This implies that the physician behaves in a manner that facilities the patient's expressing himself and that, for his part, the patient speaks openly and asks questions. The present exploratory study was undertaken to assess whether patient-centered interviews are related to positive outcomes. The study was conducted in 24 family physicians' offices where 140 doctor-patient interactions were audiotaped. Patients with both acute and chronic illnesses were included. The taped interactions were analysed using Bales Interaction Process Analysis. Ten days after the audiotaped visit the patients were interviewed in their home in order to assess their satisfaction with care, their reported compliance and to conduct a pill count.

Bivariate analysis indicated that interviews in which physicians demonstrated a high frequency of patient-centered behaviour were related to significantly higher reported compliance and close to significantly better pill counts and satisfaction. Furthermore, in most instances, when the patient and physician scores were considered in combination, there was evidence that the physician's behaviour, particularly that sort of behaviour which initiated a discussion such as an explicit request for the patient's opinion, had more impact upon outcome than did the patient behaviour.

The study suggests the importance in the setting of family practice of a patient-centred approach, one which is similar to models such as the negotiated approach to patienthood, described by psychiatrists.

Two directions for future research are suggested. Firstly, analysis of the sequence of behaviours in the interactions must be undertaken to assess the impact of timing and initiation of behaviours upon outcomes. Secondly, although the validity of the attitudes and behaviours chosen as outcome measures will be acceptable to many readers, the next step is for future studies to assess the impact of a patient-centred approach upon the ultimate outcome, patient's health.

References (37)

  • T.F. Garrity

    Medical compliance and the clinician—patient relationship: a review

  • H. Leventhal et al.

    The role of theory in the study of compliance to high blood pressure regimes

  • D.L. Roter

    Patient participation in the patient-provider interaction: the effects of patient question asking on the quality of interaction, satisfaction and comp

    Hlth Edit. Monog.

    (1977)
  • I.R. McWhinney

    An Introduction to Family Medicine

    (1981)
  • R.E. Rakel et al.

    Family Practice

    (1978)
  • D.L. Sackett

    The Standardized Compliance Questionnaire

    (1976)
  • B.S. Hulka et al.

    Scale for the measurement of attitudes toward physicians and primary medical care

    Med. Care

    (1970)
  • S.J. Zyzanski et al.

    Scale for the measurement of “satisfaction” with medical care: modifications in content, format, and scoring

    Med. Care

    (1974)
  • Cited by (351)

    • Is another relationship possible? Connoisseurship and the doctor–patient relationship for men who consume performance and image-enhancing drugs

      2020, Social Science and Medicine
      Citation Excerpt :

      This research critiques the normative and universalising conceptualisation of the doctor–patient relationship and explores the nuanced and contextual relations that reinforce the power dynamics that buttress medical authority (Heritage and Maynard, 2006; McIntosh, 1974). With a growing body of scholarship describing the content and personal experience of medical encounters (Hall and Dornan, 1988; Oakley, 1984; Ong et al., 1995; Pilnick and Dingwall, 2011; Stewart, 1984), how to improve doctor–patient interactions has become a focus. The development of the concept of patient-centredness to govern high-quality care is of particular importance (Charles and DeMaio, 1993; Mead and Bower, 2000).

    View all citing articles on Scopus
    View full text