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Doctor-patient interaction: a comparison between analysis systems

Published online by Cambridge University Press:  11 October 2011

Lidia Del Piccolo
Lidia Del Piccolo
Affiliation:
Servizio di Psicologia Medica, Istituto di Psichiatria, Università di Verona, Verona
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Summary

Objective — The medical interview has important diagnostic and therapeutic functions and requires the integration of doctor-centred and patient-centred interviewing techniques to collect accurate and complete biopsychosocial data from the patient. Analysis of the interaction between patient and doctors which occur during the medical interview allow to evaluate physicians' interview techniques and to eventually improve them. Objective — 1. To review different Interaction Analysis Systems (IAS) used to describe doctor-patient communication in terms of clinical relevance, observational strategy, reliability and behavioural and verbal contents. 2. To critically evaluate these IASs on the basis of their relevant research outcomes. Method — Previous reviews on interaction and keywords for Medline research (HealthGate) listed above were utilised to collect the relevant literature. Results — Seventeen classification systems were identified and ten were discussed in a chronological order. Starting from a general sociological or psycholinguistic approach, the IASs over the years have became more specific and detailed, focusing more and more on the medical interview and on specific topics, such as cancer or hospital medical consultations. Conclusions — When studying interactions in general practice medicine, it is important to define the significant units of interaction which allow to identify a «patient-centred approach», since this is relevant not only for obtaining reliable and complete medical and social data, but also for the recognition of patients with emotional disorders and their correct diagnosis. Listening to the patient and facilitating the expression of emotions is an important aspect of patient education too, as patients learn that talking about psychological problems to their physician is appropriate and may be therapeutic.

Riassunto

Scopo — L'intervista medica nel contesto della medicina generate ha importanti implicazioni sia sul piano diagnostico che terapeutico, mira ad un'accurata raccolta di informazioni biopsicosociali e, per essere ben condotta, implica l'applicazione di tecniche d'intervista centrate sia sul medico che sul paziente. L'analisi dell'interazione tra medico e paziente consente di valutare le tecniche d'intervista messe in atto dal medico e di individuare in modo phi preciso gli aspetti che possono essere migliorati. In particolare: 1) la revisione degli strumenti di analisi dell'interazione (IAS) adottati per descrivere la comunicazione tra medico e paziente, tenendo conto della rilevanza clinica, le strategie osservative adottate, l'attendibilita e il tipo di comportamenti analizzati; 2) la valutazione critica e l'analisi dei risultati delle ricerche svolte adottando gli strumenti considerati. Obiettivi — Gli strumenti di analisi dell'interazione considerati sono stati individuati a partire da alcune revisioni precedenti e utilizzando la ricerca Medline (HelthGate) sulle parole chiave indicate nella revisione. Risultati — Sono stati analizzati 17 sistemi di classificazione e 10 di questi sono stati descritti in ordine cronologico. Da un'analisi di tipo sociologico o psicolinguistico, si e passati, nel tempo, a un approccio specificamente impostato sulla consultazione medica e quindi a situazioni specifiche del contesto medico, quali l'ambito oncologico o ospedaliero. Conclusioni — Nello studio dell'interazione medico-paziente e importante individuare quelle categorie che risultano piu salienti per un'intervista «centrata sul paziente». Cio e rilevante non solo ai fini di una corretta individuazione dei pazienti con disagio emotivo, ma anche ai fini della corretta attribuzione del disagio stesso. L'attitudine ad ascoltare e la sollecitazione a parlare anche di tematiche emotive costituisce, infine, una forma indiretta di educazione del paziente, in quanto comprende che puo parlare con il medico anche dei suoi problemi psicologici e che cio puo avere una valenza terapeutica.

Keywords

interazione medico-pazientecomunicazione medico-pazientesistemi di analisi dell'interazionecomunicazione centrata sul pazientedoctor-patient communicationphysician-patient relationsinteraction analysis systemspatient-centred communication
Type
Articles
Information
Epidemiology and Psychiatric Sciences , Volume 7 , Issue 1 , April 1998 , pp. 52 - 67
Copyright
Copyright © Cambridge University Press 1998

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