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The Communication Patterns of Internal Medicine and Family Practice Physicians

From the Departments of Medicine (MP-O) and Health Policy and Management (DR), Johns Hopkins University, Baltimore, Maryland

Correspondence: Address correspondence to Dr. Michael Paasche-Orlow, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, 91 East Concord Street, Suite 200, Boston, MA 02118 (e-mail: mpo{at}bu.org)

Background: Although differences between Internal Medicine (IM) and Family Practice (FP) physicians have been examined in terms of care outcomes and cost, there have been few studies of specialty differences in physician-patient communication.

Methods: In 1995, 277 clinical encounters with 29 full-time, community-based FP physicians and 287 clinical encounters with 30 full-time, community based IM physicians were audiotaped. Communication was evaluated with the Roter Interaction Analysis System to reflect data gathering, patient education and counseling, rapport building, partnership building, verbal dominance, and patient-centeredness. Patient satisfaction was measured with an exit questionnaire.

Results: IM clinicians ask more biomedical questions (P = .02). FP clinicians engage in more psychosocial discussion (P = .02) and tend to engage in more emotionally supportive exchanges such as empathy and reassurance (P = .06). Significant interaction effects show differential treatment of patient subgroups by specialty; FP physicians were more verbally dominant with female patients (P < .01) and more patient-centered in their communication style with minority patients (P = .03). Although patient satisfaction was similar for IM and FP, satisfaction was more closely linked to measures of rapport and patient-centeredness for patients of FP physicians than for patients of internists.

Conclusions: The current work adds insight into FP and IM differences in both physician-patient communication and predictors of patient satisfaction.

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