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

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.