Communication patterns of primary care physicians.
OBJECTIVE
To use audiotape analysis to describe communication patterns in primary care, to relate these to ideal relationship types as described in the literature, and to explore the patterns' relationships with physician and patient characteristics and satisfaction.


METHODS
Description of routine communication in primary care based on audiotape analysis and patient and physician exit questionnaires.


METHODS
A total of 11 ambulatory clinics and private practices.


METHODS
The participants were 127 physicians and 537 patients coping with ongoing problems related to disease.


METHODS
Roter Interactional Analysis System (RIAS) and patient and physician exit satisfaction questionnaires.


RESULTS
Cluster analysis revealed 5 distinct communication patterns: (1) "narrowly biomedical," characterized by closed-ended medical questions and biomedical talk occurring in 32% of visits; (2) "expanded biomedical," like the restricted pattern but with moderate levels of psychosocial discussion occurring in 33% of the visits; (3) "biopsychosocial," reflecting a balance of psychosocial and biomedical topics (20% of the visits); (4) "psychosocial," characterized by psychosocial exchange (8% of visits); and (5) "consumerist," characterized primarily by patient questions and physician information giving (8% of visits). Biomedically focused visits were used more often with more sick, older, and lower income patients by younger, male physicians. Physician satisfaction was lowest in the narrowly biomedical pattern and highest in the consumerist pattern, while patient satisfaction was highest in the psychosocial pattern.


CONCLUSIONS
Primary care communication patterns range from narrowly biomedical to consumerist patterns and parallel the ideal forms of patient-physician relationships described in the literature.
Roter
D L
DL
Department of Health Policy and Management, the Johns Hopkins University School of Hygiene and Public Health, Baltimore, Md 21205, USA. DROTER@phnet.sph.jhu.edu
Stewart
M
M
Putnam
S M
SM
Lipkin
M
M
Stiles
W
W
Inui
T S
TS
D000704:Analysis of Variance; D016000:Cluster Analysis; D003142:Communication; D005194:Family Practice; D006801:Humans; D026706:Paternalism; D017060:Patient Satisfaction; D026684:Personal Autonomy; D010817:Physician-Patient Relations; D011795:Surveys and Questionnaires