Hostname: page-component-78c5997874-j824f Total loading time: 0 Render date: 2024-11-04T21:24:59.177Z Has data issue: false hasContentIssue false
  • English
  • Français

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
Get access Rights & Permissions [Opens in a new window]

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

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

Bales, R.F. (1950). Interaction Process Analysis. Addison Wesley: Reading MA.Google Scholar
Bateson, G. (1972). Steps to Ecology of Mind. Ballantine Books: New York..Google Scholar
Beisecker, A.E. & Beiseker, T.D. (1990). Patient information-see-king behaviors when communicating with doctors. Medical Care 1, 19–28.CrossRefGoogle Scholar
Bellantuono, C., Balestrieri, M., Ruggeri, M. & Tansella, M. (1992). Disturbi Psichici nella Medicina Generate. Il Pensiero Scientifico Editore: Roma.Google Scholar
Bensing, J.M. (1991). Doctor-Patient Communication and the Quality of Care. An Observation Study into Affective and Instrumental Behavior in General Practice. Dissertation. NIVEL: Ultrecht.Google Scholar
Bertakis, K., Roter, D. & Putnam, S.M. (1991). The relationship of physical medical interview style to patient satisfaction. Journal of Family Practice 32, 175–181.Google Scholar
Blanchard, C.G., Ruckdeschel, J.C., Blanchard, E.B., Arena, J.G., Saunders, N.L. & Malloy, E.D. (1983). Interactions between oncologists and patients during rounds. Annal of Internal Medicine 99, 694.CrossRefGoogle ScholarPubMed
Brown, J.B., Steward, M. & Tessier, S. (1995). Assessing Communication Between Patients and Doctors: a Manual for Scoring Patient-centred Communication. CSFM Working Papers Series, August.Google Scholar
Burchard, K.W. & Rowland-Morin, P.A. (1990). A new method of assessing the interpersonal skills of surgeons. Academic Medicine 65, 274–276.Google ScholarPubMed
Butow, P.N., Dunn, S.M., Tattersall, M.H.N. & Jones, Q.J. (1995). Computer-based interaction analyses of the cancer consultation. British Journal of Cancer 71, 1115–21.CrossRefGoogle Scholar
Byrne, P.S. & Long, B.E.L. (1976). Doctors Talking to Patients: A Study of the Verbal Behaviour of General Practitioners Consulting in their Surgeris. HMSO: London.Google Scholar
Cameron, L., Leventhal, E. & Leventhal, H. (1995). Seeking medical care in response to symptoms and life stress. Psychosomatic Medicine 57, 37–47.CrossRefGoogle ScholarPubMed
Cape, J.D. (1988). General Practice Consultations with Patients with Psychological Problems. Dissertation. University of London: London.Google Scholar
Cape, J.D. (1996). Psychological treatment of emotional problems by general practitioners. British Journal of Medical Psychology 69, 85–99.CrossRefGoogle ScholarPubMed
Carter, W.B., Inui, T.S., Kukull, W.A. & Haigh, V.H. (1982). Outcome-based doctor-patient interaction analysis. Identifying effective provider and patient behavior. Medical Care 6, 550–566.CrossRefGoogle Scholar
Chaitchik, S., Kreitler, S., Shaked, S., Schwartz, I. & Rosin, R. (1992). Doctor-patient communication in a cancer ward. Journal of Cancer Education 7, 41.CrossRefGoogle Scholar
Chen, C., Liang, Y. & Hsieh, W. (1989). Evaluation of clinical diagnosis and stressful life events in patients at a rural family practice center. Family Practice 6, 259–262.CrossRefGoogle Scholar
Cline, R.J. (1983). Interpersonal communication skills for enhancing physician-patient relationships. Medical Doctor State Medicine Journal 32, 272–278.Google ScholarPubMed
Cohen-Cole, S.A. (1991). The Medical Interview: the Three-Function Approach. Mosby-Year Book.Google Scholar
Comtock, L.M., Hooper, E.M. & Goodwin, J.M. (1982). Physician behaviors that correlate with patient satisfacion. Journal of Medical Education 57, 105.Google Scholar
Davenport, S., Goldberg, D. & Millar, T. (1987). How psychiatric disorders are missed during medical consultations. Lancet 22, 439–441.CrossRefGoogle Scholar
Davis, M.S. (1971). Variation in patient's compliance with doctors' orders: medical practice and doctor-patient interaction. Psychiatry in Medicine 2, 31–54.CrossRefGoogle ScholarPubMed
Engel, G.L. (1977). The need for a new medical model: a challenge for biomedicine. Science 196, 129–136.CrossRefGoogle Scholar
Eussen, G.P.H., Borgers, M.Th.A. & Visser, A.Ph. (1992). Een observatiessysteem voor de analyse van de inhoud van de communicatie tussen kankerpatienten en specialisten. Gedrag en Gezonheid 20, 2.Google Scholar
Ford, S., Fallowfield, L. & Lewis, S. (1996). Doctor-patient interactions in oncology. Social Science and Medicine 42, 1511–1519.CrossRefGoogle ScholarPubMed
Freemon, B., Negrete, V.F., Davis, M. & Korsch, B.M. (1971). Gaps in doctor-patient communication: doctor-patient interaction analysis. Pediatric Resources 5, 298.CrossRefGoogle Scholar
Freidson, E. (1970). Profession of Medicine: A Study in the Sociology of Applied Knowledge. Dodd Mead: New York.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. (1992a). Teaching psychiatric interview skills to general practitioners. In The Prevention of Depression and Anxiety (ed. Jenkins, R., Newton, J. and Young, R.). HMSO: London.Google Scholar
Gask, L. (1992b). Training general practitioners to detect and manage emotional disorders. International Review of Psychiatry 4, 293–300.CrossRefGoogle Scholar
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, 697–703.CrossRefGoogle Scholar
Goldberg, D. & Huxley, P. (1980). Mental Illness in the Community. The Pathway to Psychiatric Care. Tavistock: London.Google Scholar
Goldberg, D.P., Jenkins, L., Millar, T. & Faragher, E.B. (1993). The ability of trainee general practitioners to identify psychological distress among their patients. Psychological Medicine 23, 185–193.CrossRefGoogle ScholarPubMed
Hall, J.A., Roter, D.L. & Rand, C.S. (1981). Communication of affect between patient and physician. Journal of Health and Social Behavior 22, 18–30.CrossRefGoogle ScholarPubMed
Hall, J.A., Irish, J.T., Roter, D.L, Ehrlich, C.M. & Miller, L.H. (1994a). Satisfaction, gender, and communication in medical visits. Medical Care 12, 1216–1231.CrossRefGoogle Scholar
Hall, J.A., Irish, J.T., Roter, D.L, Ehrlich, C.M. & Miller, L.H. (1994b). Gender in medical encounters: an anlalysis of physician and patient communication in a primary care setting. Health Psychology 13, 384–392.CrossRefGoogle Scholar
Henbest, R.J. & Steward, M.A. (1989). Patient-centredness in the consultation. 1: A method for measurement. Family Practice 4, 249–253.CrossRefGoogle Scholar
Hulka, B.S., Cassel, J.C., Kupper, L.L. & Burdette, J.A. (1976). Communication, compliance and concordance between physicians and patients with prescribed medications. American Journal of Public Health 66, 847.CrossRefGoogle ScholarPubMed
Ingham, J.G. & Miller, P. (1976). The concept of prevalence applied to psychiatric disorders and symptoms. Psychological Medicine 6, 217–225.CrossRefGoogle ScholarPubMed
Inui, T.S., Carter, W.B., Kukull, W.A. & Haigh, V.H. (1982). Outcome-based doctor-patient interaction analysis. Comparison of techniques. Medical Care 6, 535–549.CrossRefGoogle Scholar
Kaplan, S.H., Gandek, B., Greenfield, S., Rogers, W.H. & Ware, J.E. (1995). Patient and visit characteristics related to physicians' participatory decision-making styles. Medical Care 12, 1176–1187.CrossRefGoogle Scholar
Kaplan, S.H., Greenfield, S., Gandek, B., Rogers, W.H. & Mare, J.E. (1996). Characteristics of physicians with participatory decision-making styles. Anual of Internal Medicine 124, 497–504.CrossRefGoogle ScholarPubMed
Katz, E., Gurwitch, M., Tsiyona, P. & Danet, B. (1967). Doctor-patient exchanges: a diagnostic approach to organizations and professions. Human Relations 22, 309.CrossRefGoogle Scholar
Lesser, A.L. (1985). Problem-based interviewing in general practice: a model. Medical Education 19, 299–304.CrossRefGoogle ScholarPubMed
Levenstein, J.H., McCracken, E.C., McWhinney, I.R., Brown, J.B., Weston, W.W., & Stewart, M.A. (1986). The patient-centred clinical method: a model for the doctor-patient interaction in family medicine. Family Practice 3, 24–30.CrossRefGoogle Scholar
Lovet, L.M., Cox, A. & Abou-Saleh, M. (1990). Teaching medical interview skills to medical students. Medicine Education 24, 243.CrossRefGoogle Scholar
Maguire, P. (1985). Barriers to psychological care of the dying. British Medical Journal Clinical Research and Education 291, 1711–1713.CrossRefGoogle ScholarPubMed
Martin, F.J. & Bass, M.J. (1989). The impact of discussion of nonmedical problems in the physician's office. Family Practice 6, 254–258.CrossRefGoogle ScholarPubMed
Mechanic, D. (1962). The concept of illness behaviour. Journal of Chronic Disorders 15, 189–194.CrossRefGoogle Scholar
Mechanic, D. (1978). Medical Sociology. Free Press: New York.Google Scholar
Mechanic, D. (1986). The concept of illness behaviour: culture, situation and personal predisposition. Editorial. Psychological Medicine 16, 1–7.CrossRefGoogle Scholar
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
Ormel, J. & Tiemens, B. (1995). Recognition and treatment of mental illness in primary care. Towards a better undertanding of a multifaced problem. General Hospital Psychiatry 17, 160–164.CrossRefGoogle Scholar
Piccinelli, M. (1996). Disturbi psichici nella mmedicina generale: le difficolta per il medico. Epidemiologia e Psichiatria Sociale 5, 151–159.CrossRefGoogle Scholar
Piccinelli, M., Pini, S., Bonizzato, P., Paltrinieri, E., Üstün, T.B., Sartorius, N & Tansella, M. (1995a). Lo studio internazionale multicentrico delFOrganizzazione Mondiale della Sanita sui disturbi psichici della medicina generale: risultati relativi all'area di Verona. Epidemiologia e Psichiatria Sociale 4, 27–50.CrossRefGoogle Scholar
Piccinelli, M., Pini, S., Bonizzato, P., Paltrinieri, E., Saltini, A., Scantamburlo, L., Bellantuono, C. & Tansella, M. (1995b). Results from the Verona Centre. In Mental Illness in General Health care. An International Study (ed. Ustiin, T.B. and Sartorius, N.), pp. 301–321. John Wiley & Sons: New York.Google Scholar
Pini, S., Piccinelli, M. & Zimmermann-Tansella, Ch. (1995). Social problems as factors affecting medical consultation: a comparison between general practice attenders and community probands with emotional distress. Psychological Medicine 25, 33–41.CrossRefGoogle ScholarPubMed
Punamäki, R. & Kokko, S.I. (1995). Content and predictors of consultation experience among Finnish primary care patients. Social Science and Medicine, 40, 231–243.CrossRefGoogle ScholarPubMed
Putnam, S.M., Stiles, W.B., Casey, Jacob M. & Sherman, J.A. (1988). Teaching the medical interview: an intervention study. Journal of General Internal Medicine 3, 338–347.CrossRefGoogle ScholarPubMed
Risko, A. (1992). Non-verbal communication between cancer patients and «others». Psycho-Oncology Letters 3, 15.Google Scholar
Roter, D.L. (1977). Patient participation in the patient-provider interaction: the affects of patient question asking on the quality of interaction, satisfaction and compliance. Health Education Monograph 5, 281.CrossRefGoogle ScholarPubMed
Roter, D.L. (1993). The Rotcr Method of Interaction Process Analysis. Johns Hopkins University: Baltimore MD.Google Scholar
Roter, D.L. & 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., Lipkin, M. & Korsgaard, A. (1991). Sex differences in patients and physicians' communication during primary care medical visits. Medical Care 11, 1083–1093.Google Scholar
Russell, R.L. & Stiles, W.B. (1979). Cathegories for classifying language in psychoterapy. Psychological Bullettin 86, 404.CrossRefGoogle Scholar
Smith, R.C. (1996). The Patient's Story. Integrated Patient-Doctor Interviewing. Little, Brown and Company: Boston.Google Scholar
Stiles, W.B. (1978). Verbal response modes and dimensions of interpersonal roles: a method of discourse analysis. Journal of Personality and Social Psychology 36, 693.CrossRefGoogle Scholar
Stiles, W.B. & Putnam, S.M. (1989). Analysis of verbal and nonverbal behavior in patient-doctor encounters. In Communicating with Medical Patients (ed. Steward, M.A. and Roter, D.L.). Sage Publications: Newbury Park CA.Google Scholar
Street, R.L. (1991a). Accomodation in medical consultations. In Context of Accomodation: Developments (ed. Giles, H., Coupland, N. and Coupland, J.), p.131. Applied Sociolinguistics, Cambridge University Press: Cambridge.CrossRefGoogle Scholar
Street, R.L. (1991b). 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
Svarstadt, B.L. (1976). Physician-patient communication and patient conformity with medical advice. In The Grouth of Bureaucratic Medicine (ed. Mechanic, D.). John Wiley & Sons: New York.Google Scholar
Tylee, A. & Freeling, P. (1987). Consultation analysis by triggers and symptoms (CATS). A new objective technique for studying consultations. Family Practice 4, 260–265.CrossRefGoogle Scholar
Van de Kar, A., Knottnerus, A., Meertens, R., Dubois, V. & Kok, G. (1992). Why do patients consult the general practitioner? Determinants of their decision. British Journal of General Practice 42, 313–316.Google ScholarPubMed
Wasserman, R.C. & Inui, T.S. (1983). Systematic analysis of clinician-patient interactions: a critique of recent approaches with suggestions for future research. Medical Care 21, 279.CrossRefGoogle ScholarPubMed
Watzlawick, P., Beavin, J.H. & Jackson, D.D. (1967). The Pragmatics of Human Communication: a Study of Interactional Patterns, Pathologies and Paradoxes. WW Norton: New York.Google Scholar
Webb, S. & Lloyd, M. (1994). Prescribing and referral in general practice: a study of patients' expectations and doctor's actions. British Journal of General Practice 44, 165–169.Google Scholar
Weston, W.W., Brown, J.B. & Stewart, M.A. (1989). Patient centred interviewing. Part.l: understanding patients' experiences. Canadian Family Physician 35, 147.Google Scholar
Wolraich MX., Albanese, M., Stone, G., Nesbitt, D., Thomson, E., Shymansky, J., Bartley, J. & Hanson, J. (1986). Medical Communication Behavior System. Medical Care 10, 891–903.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
Zimmermann-Tansella, Ch. & Siciliani, O. (1990). Social problems, social support and emotional distress in the community. In The Public Health Impact of Mental Illness (ed. Goldberg, D. and Tantam, D.), pp. 136–144. Hogrefe and Huber Publications: Toronto.Google Scholar