Article Figures & Data
Tables
Characteristic IM n = 30 (SD) FP n = 29 (SD) P Mean age 42.9 (8.9) 38.1 (4.1) .01 (t57 = 2.66) Years in practice 12.9 (9.1) 8.5 (3.2) .02 (t57 = 2.45) Sex: male/female 27/3 26/3 .97 (χ2(1) < .01) Ethnicity: white/minority 25/5 25/4 .79 (χ2(1) = .07) Practice Setting Solo 5 (17%) 11 (37%) Small group 11 (37%) 6 (21%) HMO 14 (46%) 12 (41%) .15 (χ2(2) = 3.86) Board certification 28/30 29/29 .85 (χ2(1) = .03) Characteristic IM n = 287 (%) FP n = 277 (%) P Mean Age 52.17 46.43 <.01 (t = 3.84) Female 182 (64) 171 (62) .64 (χ2(1) = 0.22) Ethnicity White 242 (84) 218 (79) Minority 42 (15) 57 (21) .07 (χ2(1) = 3.38) Income in $ 0 27 (9) 10 (4) <10,000 40 (14) 44 (16) <20,000 50 (17) 46 (17) <30,000 54 (19) 45 (16) <40,000 44 (15) 36 (13) >40,000 71 (25) 96 (35) .02 (χ2(5) = 13.39) Education <High school 74 (26) 65 (23) High school graduate 110 (38) 87 (31) <4 years’ college 39 (14) 44 (16) College graduate 31 (11) 36 (13) Postgraduate 32 (11) 45 (16) .2 (χ2(4) =5.99) Work status Full time 131 (46) 157 (57) Part time 17 (6) 13 (5) Unemployed 42 (15) 31 (11) Retired 84 (29) 55 (20) Disabled 8 (3) 7 (3) Other 4 (1) 14 (5) .01 (χ2(5) = 16.07) Visit history Prior visits 229 (80) 205 (74) No prior visits 58 (20) 72 (26) .10 (χ2(1) = 2.66) Self-rated physical health Excellent 134 (47) 144 (52) Very good 69 (24) 67 (24) Good 68 (24) 49 (18) Fair 13 (5) 16 (6) .30 (χ2(3) =3.67) Physician-rated physical health Excellent 43 (15) 49 (18) Good 167 (59) 150 (55) Fair 64 (23) 71 (26) Poor 8 (3) 5 (2) .52 (χ2(3) = 2.27) GHQ Score* 5.32 (0.33) 5.04 (0.32) P = .54 * Mean (SE).
- Table 3.
The Roter Interactional Analysis System (RIAS): Frequency of Four Code Groupings According to Physician Specialty*
Communication Behavior Unadjusted Controlled for Encounter Duration Only Expanded Model† IM FP P IM FP P IM FP P I. Data gathering a. Closed-ended biomedical questions 23.1 16.5 .02‡ 21.4 18.6 .05‡ 22.2 18.4 .01‡ b. Open-ended biomedical questions 2.9 3.0 .24 2.9 3.0 .74 2.3 2.4 .64 c. Closed-ended psychosocial questions 8.7 6.8 .11 8.9 6.8 .04‡ 8.0 6.2 .09 d. Open-ended psychosocial questions 1.6 1.5 .72 1.5 1.6 .54 2.3 2.4 .79 e. Bids for clarification 1.2 0.3 .05‡ 1.2 0.3 .06 1.0 0.1 .14 Total count 37.4 28.2 .02‡ 36.0 30.1 .02‡ 35.8 29.6 .02‡ II. Patient education and counseling a. Provides biomedical information 32.0 37.6 .19 32.8 37.3 .04‡ 31.7 34.9 .22 b. Provides psychosocial information 3.9 7.6 .02‡ 3.9 7.8 .02‡ 5.6 8.1 .02‡ c. Counsels biomedical 14.2 13.8 .78 14.1 13.9 .87 14.7 13.3 .23 d. Counsels psychosocial 7.2 8.0 .56 7.4 8.3 .39 5.2 5.5 .81 Total count 57.5 67.4 .18 59.7 66.4 .08 57.3 61.8 .25 III. Rapport building a. Personal remark 7.8 8.6 .69 8.0 8.3 .80 9.9 10.6 .31 b. Laughter 2.8 3.5 .30 2.9 3.4 .30 3.7 5.1 .03‡ c. Approval 3.8 4.7 .26 1.2 1.6 .46 4.7 5.0 .13 d. Empathy 0.3 0.5 .07 0.3 0.5 .06 0.4 0.6 .06 e. Concern 2.1 2.3 .49 2.1 2.4 .30 2.9 3.1 .35 f. Reassure 3.4 3.9 .38 3.4 4.0 .13 4.7 5.6 .06 g. Legitimate 0.6 0.7 .46 0.7 0.8 .30 0.9 1.0 .54 Total count 20.9 24.3 .34 18.6 21.0 .26 27.6 30.9 .14 IV. Partnership building a. Paraphrase 4.3 3.4 .16 3.8 3.9 .31 4.9 4.6 .47 b. Partnering 0.1 0.1 .22 0.1 0.1 .20 0.0 0.1 .46 c. Asks for opinion 0.5 0.3 .24 0.5 0.3 .18 0.5 0.4 .52 d. Asks for understanding 3.3 3.0 .58 3.1 3.1 .96 3.3 3.0 .31 e. Asks for reassurance 0.0 0.0 .62 0.0 0.0 .69 0.0 0.1 .90 Total count 8.2 6.8 .21 7.6 7.6 .97 8.5 8.3 .88 IM, internal medicine; FP, family practice.
* Frequency analysis conducted using two-tailed significance testing and generalized estimation equations to control for variable number of office visits per physician.
† Controlled for duration of encounter, experimental group, generalized health questionnaire (GHQ) score, being an established patient, physician age, patient income, patient ethnicity, and patient age.
‡ P < .05.
Dependent Variable Equation Specialty Ratio Point Estimate of Difference (95% CI) Verbal dominance Univariate IM 1.1 0.16 (0.03, 0.28)* FP 1.3 Expanded model stratified by patient gender† Male patients IM 1.1 0.05 (−0.17, 0.269) FP 1.2 Female patients IM 1.2 0.22 (0.05, 0.39)* FP 1.4 Patient-centeredness Univariate IM 1.1 0.05 (−0.14, 0.23) FP 1.1 Expanded model stratified by patient ethnicity‡ White patients IM 1.2 0.04 (−0.18, 0.26) FP 1.2 African American patients IM 1.1 0.32 (0.01, 0.62)* FP 1.4 Verbal dominance is the ratio of all physician’s talk divided by all patient’s talk. Patient-centeredness is the ratio of physician’s psychosocial codes divided by the physician’s biomedical task codes.
* P < .05
† Controlled for experimental group, physician age, patient age, patient income, and patient ethnicity.
‡ Controlled for experimental group, physician age, patient age, patient income, and patient gender.
Patient Satisfaction Internists Family Practice Rapport building communication 0.13† 0.28‡ Psychosocial communication 0.14† 0.29‡ Biomedical communication 0.06 0.06 Patient-centeredness 0.04 0.25‡ Patient-centeredness = (physician’s psychosocial codes)/(physician’s biomedical codes)
* Pairwise correlation matrix with Bonferroni adjustment
† P < .05
‡ P < .001
Functional Grouping Communication Behavior Example Data-gathering skills Question (open ended) medical condition, therapeutic regimen, lifestyle and self-care, psychosocial topics What can you tell me about the pain? How are meds working? What are you doing to keep yourself healthy? What’s happening with his father? Question (closed ended) medical condition, therapeutic regimen, lifestyle and self-care, psychosocial topics Does it hurt now? Do you take your meds? Are you still smoking? Is your wife back? Patient education and counseling skills Biomedical information about medical condition, therapeutic regimen, biomedical counseling The medication may make you drowsy. I’m prescribing an antibiotic for the infection. It’s very important for you to take the antibiotic every day and take it all. Lifestyle and self-care information Getting plenty of exercise is always a good idea. I can give you some tips on quitting. Psychosocial exchange about problems of daily living, issues about social relations, feelings, emotions It’s important to get out and do something daily. The community center is good for company. Relationship skills Positive talk (agreements, jokes, approvals, laughter) You look fantastic. You’re doing great. Negative talk (disagreements, disapproval, criticisms, corrections) I think you are wrong, you weren’t being careful. No, I wouldn’t want that. Social talk (nonmedical, chit-chat) How about those Red Sox last night? Emotional talk, concerns, reassurance, empathy, partnership legitimation I’m worried about your leg. I’m sure it will get better. It sounds like you are angry about it. We’ll get through this together. Anyone going through this would feel that way. Partnering skills Facilitation: asking for patient opinion, asking for understanding, paraphrase and interpretation, back-channel What do you think it is? Do you follow me? I heard you say you didn’t like that. Let me make sure I’ve got it right…. Uh-huh, right, go on, hmm. Orientation directions, instructions I’d like to do a physical now and talk later. Get up on the table. Now we’ll check your back.
Jump to section
Related Articles
Cited By...
- Communication quality in telephone triage conducted by general practitioners, nurses or physicians: a quasi-experimental study using the AQTT to assess audio-recorded telephone calls to out-of-hours primary care in Denmark
- Development of a tool for assessing quality of comprehensive care provided by community health workers in a community-based care programme in South Africa
- A profile of communication in primary care physician telephone consultations: application of the Roter Interaction Analysis System