When the doctor-patient interaction is viewed as a series of utterances, the temporal position of utterances becomes a central information in understanding the nature of interaction. Important concepts are interdependence and serial dependence which account for the fact that two partners influence each other in their talk and that each partner influences him/herself. Lag sequential analysis studies the associations between doctor and patient utterances in a two-way contingency table (lag one sequences) and is used for exploratory purposes. Log-linear modelling, based on multi-way contingency tables, is used as an extension of lag-sequential analysis to study longer sequences.

Markov chains test sequences in terms of processes with the aim to find predictive models and require a theory driven approach. Pattern recognition aims to discover regularities in the temporal evolution of the utterance sequences. Theory driven applications analyse manifest patterns in terms of their conditional probability distribution while empirically driven applications are used to detect “hidden” patterns. These different approaches to sequential data can be regarded as complementary tools to describe the doctor patient consultations at various levels of complexity.

Declaration of Interest: none.

In psichiatria, ormai da alcuni anni, accanto alle revisioni classiche della letteratura, le cosiddette revisioni narrative, gli articoli cioè in cui gli esperti di ciascun settore passano in rassegna le conoscenze riguardanti un determinato argomento per trarne conclusioni utili alia pratica clinica, si è progressivamente affermato un nuovo tipo di rassegna della letteratura, denominato revisione sistematica. Questo è avvenuto a seguito dell'altrettanto forte affermazione dell'idea secondo cui le decisioni in medicina devono basarsi sulle evidenze scientifiche a nostra disposizione. Le evidenze scientifiche sono meglio dette prove di efficacia, e il termine che descrive questo movimento è medicina basata sulle prove di efficacia (Barbui et al, 2002). Secondo il paradigma della medicina basata sulle prove di efficacia (o evidence-based medicine, da cui la sigla EBM) le revisioni sistematiche rappresentano lo strumento piu idoneo per riassumere le prove di efficacia esistenti per ogni argomento. Scopo di questo editoriale è chiarire che cosa sono le prove di efficacia in medicina ed esemplificare come queste ultime vengono correntemente utilizzate nella preparazione e nel mantenimento delle revisioni sistematiche. Obiettivo ultimo è discutere il possibile ruolo delle revisioni sistematiche nel supportare il processo di acquisizione di competenze che permettano di prendere decisioni in ambito psichiatrico.

The inclusion of communication skills as a core competency in health care curricula, has led to the need to define adequacy in this area. Developments in the field of interview analysis have meant that robust and objective ways of assessing interview behaviours are now available; however, these systems in themselves do not provide a model for assessing competency. As adequacy in interviewing is contextually driven, this paper discusses the potential of using patient centeredness to address the issue. It suggests two ways in which patient centeredness may be operationally defined, permitting data available from current rating systems, and from a new system shortly to be available, to be used to assess interviewing competency.

Declaration of Interest: the authors would like to acknowledge Cancer Research UK for funding this work.

Aims – The aim of this small scale study was to explore interaction sequences during the medical consultation. Specific attention was paid to how doctors responded to patient's concerns and worries. Empathic behaviours ( e.g. concern, partnership, legitimising) and facilitating behaviours (e.g. paraphrasing, agreement) were considered as an adequate response to a patient's concern. Methods – Nine consultations of nine different GPs were randomly selected from a sample of 1600 videotaped doctor-patient consultations, that were all rated with the Roter Interaction Analysis System. Each consultation contained at least 9 utterances of patient's concern. It was investigated how doctors respond within five lags of utterances after a patient's concern. Results – The results showed that doctors more often responded to a patient's concern in a facilitative way than in an empathic way. When an empathic response was given, it appeared mostly during the first utterance after the patient expressed a concern. Conclusions – The findings indicate that sequential analysis is appropriate to investigate a health care provider's specific style of responding. Based on the problems emerged during the sequential analysis, further exploration of the method is recommended.

Declaration of Interest: none.