The medical visit context of treatment decision-making and the therapeutic relationship.

The ascendance of the autonomy paradigm in treatment decision-making has evolved over the past several decades to the point where few bioethicists would question that it is the guiding value driving health-care provider behaviour. In achieving quasi-legal status, decision-making has come to be regarded as a formality largely removed from the broader context of medical communication and the therapeutic relationship within which care is delivered. Moreover, disregard for individual patient preference, resistance, reluctance, or incompetence has at times produced pro forma and useless autonomy rituals.

Medical communication and gender: a summary of research.

Communication patterns between physicians and patients during the medical visit reveal behavioral gender differences. Studies suggest varying satisfaction levels depending on physician gender. The communication style of female physicians often includes slightly more focus on the patient's emotional and psychosocial concerns, more positively toned communications, and a more egalitarian style reflected in increased levels of patient participation.

The medical interview: differences between adult and geriatric outpatients.

Background: There is a perception that primary care physicians spend less time with older patients and little is known about physician and older patient satisfaction during clinical encounters.

Objective: To determine how primary care interviews of geriatric patients differ from those of other adults.

Design: Descriptive, analytic study.

An evaluation of the impact of training Honduran health care providers in interpersonal communication.

Objective: To evaluate the impact of interpersonal communication (IPC) training on practice and patient satisfaction and to determine the acceptability of this training to providers in a developing country.

Design: The study used a pre-post design with treatment and control groups. Data collection methods included interaction analysis of audio-taped clinical encounters, patient exit interviews, and a self-administered questionnaire for health providers.

Measuring patient expectations: does the instrument affect satisfaction or expectations?

Background: Fulfillment of patients' expectations may influence health care utilization, affect patient satisfaction, and be used to indicate quality of care. Several different instruments have been used to measure expectations, yet little is known about how different assessment methods affect outcomes.

Objective: The object of the study was to determine whether different measurement instruments elicit different numbers and types of expectations and different levels of patient satisfaction.

Experts practice what they preach: A descriptive study of best and normative practices in end-of-life discussions.

Background: Advance directives (ADs) are widely regarded as the best available mechanism to ensure that patients' wishes about medical treatment at the end of life are respected. However, observational studies suggest that these discussions often fail to meet their stated goals.

Objectives: To explore best practices by describing what physicians who are considered expert in the area of end of-life bioethics or medical communication do when discussing ADs with their patients and to explore the ways in which best practices of the expert group might differ in content or style from normative practice derived from primary care physicians' discussions of ADs with their patients collected as part of an earlier study.

"If it bleeds it leads"? Attributes of TV health news stories that drive viewer attention.

Objective: Health advocates increasing y use the news media to educate the public. However, little is known about what motivates individuals to pay attention to health news. This study investigated which characteristics of TV health news stories attract viewer interest.

Predictors of adherence to behavior change interventions in the elderly.

Considering factors at the individual, interpersonal, and environmental level may enhance adherence to interventions in the elderly. A collaborative practitioner-participant relationship is also essential. Control Clin Trials 2000;21:200S-205S

The enduring and evolving nature of the patient-physician relationship.

Just as the molecular and chemistry oriented sciences were adopted as the 20th century medical paradigm, incorporation of the patient's perspective into a relationship-centered medical paradigm has been suggested as appropriate for the 21st century. It is the medical dialogue that provides the fundamental vehicle through which the paradigmatic battle of perspectives is waged and the therapeutic relationship is defined. In many regards, the primary challenge to the field is the development of operationally defined and measurable indicators of medical communication that will provide a valid representation of the conceptual models of the therapeutic relationship.

Using entertainment television to build a context for prevention news stories.

Unlabelled: OBJECTIVE. A nationally syndicated television news series called "Following ER" was developed to educate viewers about the health issues dramatized on "ER," NBC's award-winning medical drama. This study investigated the impact of this prime-time link on viewer attention, satisfaction, information recall, and perceptions about the uses and gratifications delivered by a news story.

Effects of obstetrician gender on communication and patient satisfaction.

Objective: To describe patient-obstetrician communication during the first prenatal visit and its relationship to physician gender and patient satisfaction.

Methods: The first prenatal visit of 87 women with 21 obstetricians (11 male and ten female) was audiotaped and analyzed using the Roter Interaction Analysis System. Patient satisfaction was measured by postvisit questionnaire.

Involving family members in cancer care: focus group considerations of patients and oncological providers.

Family members are an integral part of a patient's cancer care from the moment the diagnosis is delivered to the conclusion of treatment. Family members bring with them a range of emotional reactions, interpersonal dynamics and expectations for the care the patient receives. This study is part of a multi-institutional project to continue to improve the process of cancer care.

The outpatient medical encounter and elderly patients.

There is little evidence of systematic negative bias against older patients in medical visits. The nature of the current narrative review, largely based on studies conducted after 1985, is consistent with the author's previous metaanalysis of over 40 studies published between 1965 and 1985. In that review, based on videotapes or audiotapes of medical visits, consistent relationships between patient age and physicians' interviewing skills were found.

Asking questions about medication: analysis of physician-patient interactions and physician perceptions.

Objectives: The purpose of this research was to examine physicians' and patients' question-asking about medications during medical encounters.

Methods: A dataset of 467 audiotapes and transcripts of outpatient visits, as well as postvisit interviews with chronic disease patients and their primary care physicians, was analyzed.

Results: All patients took at least one prescribed medication and were using an average of 3.

Inaccuracies in physicians' perceptions of their patients.

Objective: The objective was to assess primary care physicians' awareness of their patients' rated emotions, satisfaction, and opinion of the quality of their communication.

Design: Diabetic patients (n = 261) and their primary care physicians (n = 44) each filled in a questionnaire following a routine medical visit. Patients were asked about the quality of communication with their physician, their satisfaction, and their experience of six emotions.

Counseling by primary care physicians of patients who disclose psychosocial problems.

Background: Most descriptive studies of psychosocial counseling by US primary care physicians (PCPs) have relied on the PCPs' recollections rather than researchers' observations of actual visit content. The latter approach should yield more accurate measurement of counseling frequency and duration.

Methods: Our sample consisted of 308 patients whose scores signified psychological distress on the 28-item General Health Questionnaire.

Psychosocial problem disclosure by primary care patients.

The vast majority of psychologically distressed primary care patients present exclusively somatic concerns at the outsets of their visits. However, it is not known how often such patients subsequently disclose psychosocial problems to their primary care physicians (PCPs) and what variables predict such disclosures. Our objectives were to measure, among psychologically distressed primary care patients, the frequency of disclosure of psychosocial problems (disclosure), the effects of prior psychosocial inquiry (prior inquiry) by PCPs and various patient variables on disclosure, and the effect of disclosure on mental health problem recognition (recognition) by PCPs.

Why physician gender matters in shaping the physician-patient relationship.

Societal values regarding the nature and consequences of patient autonomy and medical paternalism underscore the current debates surrounding informed consent and shared decision making. The debate is significant in that it both reflects and determines normative expectations for physician and patient conduct as well as the nature and form of the therapeutic relationship. Analysis of the literature describing communication differences between physicians of different genders indicates that female physicians show a greater affinity for collaborative models of patient-physician relationship than do their male colleagues.

Patient-provider communication during the emergency department care of children with asthma. The National Cooperative Inner-City Asthma Study, National Institute of Allergy and Infectious Diseases, NIH, Bethesda, MD.

Objectives: Poor children's reliance on emergency facilities is one factor implicated in the rise of morbidity attributed to asthma. Although studies have examined doctor-patient communication during routine pediatric visits, little data are available about communication during emergency care. This study sought to describe communication during emergency treatment of childhood asthma to learn if a "patient-centered" provider style was associated with increased parent satisfaction and increased parent and child participation.

Patient race and psychotropic prescribing during medical encounters.

This paper examines how patient race, rating of physical and emotional health, expression of physical, emotional, and social problem symptoms, and physician perceptions of patients' physical health, emotional health, and social problems influence psychotropic prescribing in patients with chronic illness. Data were collected at 11 geographic areas in the United States and Canada. Patient visits were audio-tape recorded and research assistants interviewed each patient after their medical visit.

The effects of a continuing medical education programme in interpersonal communication skills on doctor practice and patient satisfaction in Trinidad and Tobago.

This study investigates the effects of a brief training programme on the communication skills of doctors in ambulatory care settings in Trinidad and Tobago. Evaluation of doctor performance is based on analysis of audiotapes of doctors with their patients during routine clinic visits and on patient satisfaction ratings. A pre-test/post-test quasi-experimental study design was used to evaluate the effects of exposure to the training programme.

Effectiveness of interventions to improve patient compliance: a meta-analysis.

Objectives: This article summarizes the results of 153 studies published between 1977 and 1994 that evaluated the effectiveness of interventions to improve patient compliance with medical regimens.

Methods: The compliance interventions were classified by theoretical focus into educational, behavioral, and affective categories within which specific intervention strategies were further distinguished. The compliance indicators broadly represent five classes of compliance-related assessments: (1) health outcomes (eg, blood pressure and hospitalization), (2) direct indicators (eg, urine and blood tracers and weight change), (3) indirect indicators (eg, pill count and refill records), (4) subjective report (eg, patients' or others' reports), and (5) utilization (appointment making and keeping and use of preventive services).