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Communication patterns between doctors and patients is "autopsied"
Is your doctor a "paternalistic" communicator? A "consumerist" communicator? A "technical interpreter?" Debra Roter, Dr PH, professor, Health Policy and Management, Johns Hopkins School of Public Health, recently analyzed the content of patient-physician communication and identified five communication patterns that directly impact both patient and physician satisfaction, as well as the quality of care. The study appears in the January 22 issue of The Journal of the American Medical Association (JAMA).
A study of 537 audio tapes of medical interviews between 127 physicians and patients revealed five patterns of communication. Verbal dominance and verbal control on the part of the physicians in each interview was evaluated and coded. Both physicians and patients were later surveyed about their satisfaction with the medical interview.
While most physicians tended toward the "paternal,"dominating the interview with biomedical questions, the "bio-psycho-social" pattern, where patient and doctor freely discussed a range of physical and emotional questions, lowered physician verbal dominance and control, but raised the satisfaction for both patient and physician.
The "narrowly biomedical" pattern, dominated by physicians asking medical questions, and by far the most common pattern, was least pleasing to both patients and physicians. "It was less pleasing to both patients and doctors, yet this kind of visit is the norm," said Dr. Roter. " Which means that something is wrong with the system."
Both doctors and patients reported higher satisfaction with medical interviews having a good mix of biomedical and psychosocial talk. Least pleasing to both doctors and patients was the "narrow biomedical pattern" where talk was restricted to biomedical hard facts with little to no discussion of 'how do you feel?' Many doctors considered the "consumerist" pattern interviews -- where doctors only answered patient questions -- the best use of their time.
"The communication patterns we analyzed reflect the routine business of medicine and provide a useful benchmark by which the content and quality of patient-physician communication can be measured," said Dr. Roter. "Given the dramatic changes in health care delivery, our findings must be given full and serious consideration for conceptualizing the physician-patient relationship of the future." Funding for this study came from The National Fund for Medical Education.
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