Hostname: page-component-78c5997874-fbnjt Total loading time: 0 Render date: 2024-11-05T13:35:41.508Z Has data issue: false hasContentIssue false
  • English
  • Français

An instrument for evaluating medical interview in general practice: the VR-MICS/D (Verona-Medical Interview Classification System/Doctor)

Published online by Cambridge University Press:  11 October 2011

Anna Saltini ,
Davide Cappellari ,
Paola Cellerino ,
Lidia Del Piccolo  and
Christa Zimmermann
Anna Saltini*
Affiliation:
Servizio di Psicologia Medica, Istituto di Psichiatria, Università di Verona
Davide Cappellari
Affiliation:
Servizio di Psicologia Medica, Istituto di Psichiatria, Università di Verona
Paola Cellerino
Affiliation:
Servizio di Psicologia Medica, Istituto di Psichiatria, Università di Verona
Lidia Del Piccolo
Affiliation:
Servizio di Psicologia Medica, Istituto di Psichiatria, Università di Verona
Christa Zimmermann
Affiliation:
Servizio di Psicologia Medica, Istituto di Psichiatria, Università di Verona
*
Indirizzo per la corrispondenza: Dr.ssa A. Saltini, Servizio di Psicologia Medica, Istituto di Psichiatria, Ospedale Policlinico, 37134 Verona. Fax +39 — 045-585.871 E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Summary

Objective - To assess the reliability of the VR-MICS/D (Verona-Medical Interview Classification System/Doctor) and to identify the verbal behaviour by general practitioners in interviews conducted with primary care attenders with medical complaints and emotional distress. Setting - Two general practices in South-Verona. Sample - 100 primary care patients attending for a new illness episode with a GHQ-12 score > 3. The five participating GPs contributed each with 20 audiotaped interviews of 10 patients judged by GP as emotionally distressed and of 10 judged without emotional distress. Main outcome measures — The VR-MICS/D classifies GPs' verbal behaviour during the medical interview into 16 categories in terms of form (question or statement) and content and allows to assess their interview skills. Procedure - Two raters classified 30 interviews (15 with patients judged by their GP as emotionally distressed and 15 with patients judged without emotional distress). Having established satisfactory reliability, the overall verbal performance, based on 100 interviews, was assessed and GPs' verbal behaviours with patients judged as emotionally distressed was compared with that adopted with patients judged without emotional distress. Results - The reliability was satisfactory (Kappa 0.93). Percentage agreements for categories varied between 78.2% and 96.4%. The most frequent verbal behaviours were closed ended questions and information giving (58% of a total of 5522 classified verbal units). Interviews with patients judged as emotional distressed contained a greater number of psychological and psychosocial contents, facilitating comments and clarifications. These differences, however, were small, despite their statistical significance. Conclusions - The VR-MICS/D is a reliable measure for describing GPs' verbal behaviour during the interview with emotional distressed patients. The interview style of the GPs in this study was similar to that reported in the literature for GPs without formal training in communication skills and was characterised by a prevalently doctor-centred approach. This approach, particularly with emotional distressed patients, has severe limitations and underlines the necessity of the introduction of communication skills training.

Riassunto

Scopo - Valutare l'attendibilita del VR-MICS/D (Verona-Medical Interview Classification Systeml/Doctor) e identificare gli interventi adottati dai medici di medicina generale durante la conduzione dell'intervista con pazienti con disturbi organici e disagio emotivo. Setting - Lo studio e stato condotto nel territorio di Verona-Sud, presso due ambulatori di Medicina Generale. Campione - 100 pazienti che hanno consultato i medici per un problema di salute nuovo e che hanno riportato al GHQ-12 un punteggio > 3. I cinque medici coinvolti nello studio hanno contribuito ciascuno con 20 interviste audioregistrate (10 condotte con pazienti giudicati con disagio emotivo e 10 condotte con pazienti senza disagio emotivo, secondo il giudizio dei medici). Principali misure utilizzate — Il VR-MICS/D consente di classificare il comportamento verbale adottato dal medico durante la conduzione dell'intervista e consente di valutarne lo stile. Lo strumento à costituito da 16 categorie definite in base a formulazione (domanda, affermazdone) e contenuto. Procedura - Due rater hanno classificato 30 interviste (15 condotte con pazienti giudicati dai medici con disagio emotivo e 15 condotte con pazienti senza disagio emotivo, secondo il giudizio dei medici). Dopo aver verificato l'attendibilita del VR-MICS/D, e stata valutata la performance dei medici (classificazione delle 100 interviste) e sono stati confrontati i comportamenti verbali adottati con pazienti giudicati con disagio emotivo e senza disagio, secondo il giudizio dei medici. Risultati - Il VR-MICS/D ha dimostrato una buona attendibilita (Kappa di Cohen 0.93). La percentuale di accordo delle categorie è compresa tra 78.2% e 96.4%. I comportamenti verbali piu frequenti sono «domande chiuse» e «dare informazioni» (55.0% sul totale dei comportamenti verbali classificati n = 5522). Ciò che contraddistingue le interviste condotte con pazienti giudicati dai medici con disagio emotivo sono gli specifici contenuti affrontati (psicologico e psicosociale) e i commenti di chiarificazione e di facilitazione. Queste differenze non sono comunque marcate, nonostante siano statisticamente significative. Conclusioni - Il VR-MICS/D è uno strumento attendibile che permette di classificare il comportamento verbale adottato dai medici durante la conduzione delle interviste con pazienti con disagio emotivo. Lo stile di intervista dei medici che hanno partecipato allo studio e simile a quello descritto in letteratura per i medici che non hanno ricevuto una formazione alle tecniche comunicative ed è caratterizzato da un approccio essenzialmente centrato sul medico e sulle sue conoscenze. Questo tipo di approccio, in particolare con pazienti con disagio emotivo, comporta notevoli limitazioni ed evidenzia la necessita di introdurre interventi di formazione alle tecniche di intervista.

Keywords

comunicazione medico-pazienteclassificazione dell'intervista medicadisagio emotivodoctor-patient communicationmedical interview classificationemotional distress
Type
Articles
Information
Epidemiology and Psychiatric Sciences , Volume 7 , Issue 3 , December 1998 , pp. 210 - 223
Copyright
Copyright © Cambridge University Press 1998

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

BIBLIOGRAFIA

Barsky, A.J. (1981). Hidden reasons some patients visit doctors. Annals of Internal Medicine 94, 492–498.CrossRefGoogle ScholarPubMed
Beckman, H.B. & Frankel, R. M. (1984). The effect of physician behavior on the collection of data. Annals of Internal Medicine 101, 692–696.CrossRefGoogle ScholarPubMed
Bellantuono, C., Fiorio, R., Zanotelli, R. & Tansella, M. (1987). Psychiatric screening in general practice in Italy. Social Psychiatry 22, 113–117.CrossRefGoogle ScholarPubMed
Bensing, J.M. (1991a). Doctor-patient Communication and the Quality of Care. An Observation study into Affective and Instrumental Behavior in General Practice. Dissertation. NIVEL: Utrecht.Google Scholar
Bensing, J.M. (1991b). Doctor-patient communication and the quality of care. Social Sciences and Medicine 32, 1301–1310.CrossRefGoogle ScholarPubMed
Bertakis, K.D., Roter, D. & Putman, S.M. (1991). The relationship of physician medical interview style to patient satisfaction. Journal of Family Practice 32, 175–181.Google ScholarPubMed
Blanchard, C.G., Ruckdeschel, J.C., Fletcher, B.A. & Blanchard, E.B. (1986). The impact of oncologists' behaviors on patient satisfaction with morning rounds. Cancer 58, 387–391.3.0.CO;2-3>CrossRefGoogle ScholarPubMed
Carter, W.B., Inui, T.S., Kukull, W. A. & Haigh, V.H. (1982). Outcome-based doctor-patient interaction analysis. II. Identifying effective provider and patient behaviour. Medical Care 20, 550–566.CrossRefGoogle Scholar
Davenport, S., Goldberg, D. & Millar, T. (1987). How psychiatric disorders are missed during medical consultations. Lancet ii, 439–441.CrossRefGoogle Scholar
Del Piccolo, L. (1998). L'interazione medico-paziente: sistemi di analtsi a confronto. Epidemiologia e Psichiatria Sociale 7, 52–67.CrossRefGoogle Scholar
Eisenberg, L. (1988). The social construction of mental illness. Psychological Medicine 18, 1–9.CrossRefGoogle ScholarPubMed
Engel, G.L. (1977). The need for a new medical model: a challenge for biomedicine. Science 196, 129–136.CrossRefGoogle Scholar
Engel, G.L. (1980). The clinical application of the biopsychosocial model. American Journal of Psychiatry 137, 535–544.Google ScholarPubMed
Engel, G.L. (1988). How much longer must medicine's science be bound by a seventeenth century world view? In The Task of Medicine (ed. White, K.). The Henry J. Kaiser Family Foundation: Menlo Park, CA.Google Scholar
Freeling, P. & Tylee, A. (1992). Depression in general practice. In Handbook of Affective Disorders (ed. Paykel, E.S.). Churchill Livingstone: Edinburgh.Google Scholar
Gask, L., McGrath, G., Goldberg, D. & Millar, T. (1987). Improving the psychiatric skills of established general practitioners: evaluation of group teaching. Medical Education 21, 362–368.CrossRefGoogle ScholarPubMed
Gask, L., Goldberg, D.P., Lesser, A. & Millar, T. (1988). Improving the psychiatric skills of the general practice trainee: an evaluation of a group training course. Medical Education 22, 132–138.CrossRefGoogle ScholarPubMed
Gask, L., Goldberg, D., Porter, R. & Creed, F. (1989). The treatment of somatization: evaluation of a teaching package with general practice trainees. Journal of Psychosomatic Research 6, 703.Google Scholar
Goldberg, D.P. (1972). The Detection of Psychiatric Illness by Questionnaire. Maudsley Monographn.21. Oxford University Press: London.Google Scholar
Goldberg, D.P. & Williams, P. (1988). A User's Guide to the GHQ. NFER Nelson: London.Google Scholar
Goldberg, D.P., Steele, J.J., Johnson, A. & Smith, C. (1982). Ability of primary care physicians to make accurate ratings of psychiatric symptoms. Archives of General Psychiatry 39, 829-CrossRefGoogle ScholarPubMed
Goldberg, D.P., Jenkins, L., Millar, T. & Faragher, E.B. (1993). The ability of trainee general pratictioner to identify psychological distress among their patients. Psychological Medicine 23, 193.CrossRefGoogle Scholar
Hall, J.A., Roter, D.L. & Katz, N.R. (1987). Task versus socioemotional behaviour. Medical Care 25, 399–408.CrossRefGoogle Scholar
Hall, J.A., Roter, D.L.Katz, N.R. (1988). Meta-analysis of correlates of provider behaviour in medical encounters. Medical Care 26, 657–675.CrossRefGoogle ScholarPubMed
Hall, J.A., Irish, J.T., Roter, D., Ehrlich, C.M. & Miller, L.H. (1994). Gender in medical encounters: an analysis of physician and patient communication in primary care setting. Health Psychology 13, 384–392.CrossRefGoogle ScholarPubMed
Higgins, P.M. (1984). Things aren't what they seem. Journal of Royal Society of Medicine 77, 728–737.CrossRefGoogle Scholar
Inui, T.S., Carter, W.B., Kukull, W.A. et al. (1982). Outcome-based doctor-patient interaction analysis. I: Comparison of techniques. Medical Care 20, 535–550.CrossRefGoogle ScholarPubMed
Levinson, W. & Roter, D. (1995). Physicians' psychosocial beliefs correlate with their patient communication skills. Journal General Internal Medicine 10, 375–379.CrossRefGoogle ScholarPubMed
Levinson, W., Roter, D., Mullooly, J.P., Dull, V.T. & Frankel, R.M. (1997). Physician-patient communication. The relationship with malpractice claims among primary care physicians and surgeons. Journal of American Medical Association 19, 553–559.CrossRefGoogle Scholar
Marks, J., Goldberg, D.P. & Hillier, V.F. (1979). Determinants the ability of general pratictioners to detect psychiatric illness. Psychological Medicine 9, 337–353.CrossRefGoogle Scholar
Mechanic, D. (1962). The concept of illness behaviour. Journal Chronic Disorders 15, 189–194.CrossRefGoogle Scholar
Mechanic, D. (1986). The concept of illness behaviour: culture, situation and personal predisposition. Psychological Medicine 16, 1–7.CrossRefGoogle ScholarPubMed
Ong, L.M.L., De Haes, J.C.J.M., Hoos, A.M. & Lammes, F.B. (1995). Doctor-patient communication: A review of the literature. Social Science and Medicine 7, 903–918.CrossRefGoogle Scholar
Piccinelli, M., Bisoffi, G., Bon, G., Cunico, L. & Tansella, M. (1993). Validity and test-retest reliability of the Italian version of the 12 items general health Questionnaire in general practice: comparison between three scoring methods. Comprehensive Psychiatry 34, 198–205.CrossRefGoogle Scholar
Roter, D.L. (1984). Patient question asking in physician-patient interaction. Health Psychology 3, 395–409.CrossRefGoogle ScholarPubMed
Roter, D.L(1993). The Roter Method of Interaction Process Analysis. Johns Hopkins University: Baltimore.Google Scholar
Roter, D. & Frankel, R. (1992). Quantitative and qualitative approaches to the evaluation of the medical dialogue. Social Sciences and Medicine 10, 1097–1103.CrossRefGoogle Scholar
Roter, D.L. & Hall, J.A. (1987). Physicians' interviewing styles and medical information obtained from patients. Journal of Geneneral Internal Medicine 2, 325–329.CrossRefGoogle ScholarPubMed
Roter, D.L., Hall, J.A. & Katz, N.R. (1987). Relations between physicians' behaviours and analogue patients' satisfaction, recall and impressions. Medical Care 25, 437–451.CrossRefGoogle ScholarPubMed
Roter, L.D., Hall, J.A. & Katz, N.R. (1988). Patient-physician communication: a descriptive summary of the litterature. Patient Education and Counseling 12, 99–119.CrossRefGoogle Scholar
Roter, D.L., Lipkin, M. & Korsgaard, A. (1991). Sex differences in patients and physicians' communication during primary care medical visits. Medical Care 11, 1083–1093.Google Scholar
Saltini, A. (1997a). Il riconoscimento dei disturbi emotivi nella medicina di base: il ruolo della comunicazione medico-paziente. Quaderni Italian! di Psichiatra 1, 5–27.Google Scholar
Saltini, A. (1997b). La prescrizione del trattamento ed il problema dell'adesione alia cura da parte del paziente. Recenti Progressi in Medicina 88, 439–447.Google Scholar
Saltini, A. (1997c). L'intervista Medica e il Riconoscimento del Disagio Emotivo nella Medicina di Base. Tesi di Dottorato di Ricerca in Scienze Psichiatriche. Servizio di Psicologia Medica, Università di Verona: Verona.Google Scholar
Shea, S. C. (1988). Psychiatric Interviewing. The Art of Understanding. Saunders Company: Philadelphia.Google Scholar
Smith, R. (1997). La Storia del Paziente. Un Approccio Integrato all Intervista Medica. Il Pensiero Scientifico Editore: Roma.Google Scholar
Smith, R.C. & Hoppe, R.B. (1991). The patient's story: integrating the patientand physician-centered approaches to interviewing. Annals of Internal Medicine 115, 470–477.CrossRefGoogle Scholar
Smith, C.K., Polis, E. & Hadac, R.R. (1981). Characteristics of the initial medical interview associated with patient satisfaction and understanding. Journal of Family Practice 12, 283–290.Google ScholarPubMed
Street, R.L. (1991). Information-giving in medical consultations: the influence of patients' communicative styles and personal characteristics. Social Sciences and Medicine 32, 541–548.CrossRefGoogle ScholarPubMed
Street, R.L. (1992). Communicative styles and adaptations in physician-parent consultations. Social Sciences and Medicine 10, 1155–1163.CrossRefGoogle Scholar
Suchman, A.L. & Matthews, D.A. (1988). What makes the patientdoctor relationship therapeutic? Exploring the connexional dimension of medical care. Annals of Internal Medicine 108, 125–30.CrossRefGoogle ScholarPubMed
Tate, P. (1994). The Doctor's Communication Handbook. Radcliffe Medical Press: Oxford and New York.Google Scholar
White, J., Levinson, W. & Roter, D. (1994). «Oh, by the way»: the closing moments of the medical visit. Journal of General Internal Medicine 9, 24–28.CrossRefGoogle ScholarPubMed
Wolraich, M.L., Albanese, M., Stone, G., Nesbitt, D., Thomson, E., Shymansky, J., Bartley, J. & Hanson, J. (1986). Medical Communication Behavior System: an interactional analysis system for medical interactions. Medical Care 10, 891–903.CrossRefGoogle Scholar
Zimmermann, Ch. (1996). L'intervista medica e la comunicazione medico-paziente. In Psichiatria nella Pratica Medica, di Goldberg, D., Benjamin, S. e Creed, F.. Edizione italiana a cura di M. Tansella. Il Pensiero Scientifico Editore: Roma.Google Scholar
Zimmermann, Ch. (1997). Introduzione. In La Storia del Paziente. Un Approccio Integrato all'Intervista Medica, di Smith, R.. Il Pensiero Scientifico Editore: Roma.Google Scholar
Zimmermann, Ch. & Tansella, M. (1996). Psychosocial factors and physical illness in primary care. Promoting the biopsychosocial model in medical practice. Journal of Psychosomatic Research 40, 351–358.CrossRefGoogle ScholarPubMed