Levels of physician involvement with patients and their families. A model for teaching and research.
BACKGROUND
We present an educational model that describes physician skills for addressing psychosocial concerns of patients, ranging from basic medical questions to in-depth psychotherapy. This model improves upon previously published models by integrating into one hierarchy levels of physician involvement with individual patients and levels of involvement with families.


METHODS
Ten faculty family physicians were videotaped during 200 office visits. Interviews were categorized according to the model, with a 79% interrater agreement.


RESULTS
Most visits involved the lower three levels of physician involvement (41%, level 1; 35.5%, level 2; and 23%, level 3). Discussion of family context occurred in a majority (58.5%) of visits, primarily when another family member was in the room and during preventive care visits. Higher levels were associated with longer visits--about 3 minutes more for each additional level.


CONCLUSIONS
This investigation suggests that the levels of physician involvement model can be reliably measured. This model may be a useful tool for education and research, particularly the study of physician interview skills appropriate to family medicine.
Marvel
M K
MK
Fort Collins Family Medicine Residency Program, CO.
Schilling
R
R
Doherty
W J
WJ
Baird
M A
MA
D000328:Adult; D005180:Faculty, Medical; D005194:Family Practice / Q000193:education; D005260:Female; D006801:Humans; D007396:Internship and Residency; D008297:Male; D008875:Middle Aged; D015146:Midwestern United States; D017145:Models, Educational; D009819:Office Visits / Q000706:statistics & numerical data; D010353:Patient Education as Topic; D010817:Physician-Patient Relations; D010821:Physicians, Family / Q000193:education; D011613:Psychotherapy