title: Physician practice styles and patient outcomes: differences between family practice and general internal medicine.
abstract: OBJECTIVE
  This study compared patient health status, patient satisfaction, and physician practice style between family practice and internal medicine.
  
  
  METHODS
  New adult patients (n = 509) were prospectively and randomly assigned to family practice or internal medicine clinics at a university medical center and followed for 1 year of care. Practice styles were characterized by the Davis Observation Code. Self-reported health status (Medical Outcomes Study, Short Form-36) and patient satisfaction also were measured.
  
  
  RESULTS
  There were no significantly different changes in self-reported health status or patient satisfaction between family practice and internal medicine physicians during the course of the study. Family practice initial encounters, however, were characterized by a style placing greater relative emphasis on health behavior and counseling, whereas internists used a more technical style. Improved health status scores after treatment were predicted by a practice style emphasis on counseling, whereas improvements in patient satisfaction scores were predicted by a style of care stressing patient activation. Although this is the first known randomized trial studying this issue, the conclusions are limited by a 38% loss of patients from enrollment to care and a loss of 18% at the 1-year follow-up evaluation.
  
  
  CONCLUSIONS
  There were significant differences in practice styles between family physicians and internists; however, it was the physician's behavior, not specialty per se, that affected patient outcomes. A practice style emphasizing psychosocial aspects of care was predictive of improvements in patient health status, whereas a practice style emphasizing patient activation was predictive of improvements in patient satisfaction.
authors.affiliation: Department of Family and Community Medicine, University of California, Davis, Sacramento 95817, USA.
authors.forename: K D
authors.initials: KD
authors.lastname: Bertakis
authors.forename: E J
authors.initials: EJ
authors.lastname: Callahan
authors.forename: L J
authors.initials: LJ
authors.lastname: Helms
authors.forename: R
authors.initials: R
authors.lastname: Azari
authors.forename: J A
authors.initials: JA
authors.lastname: Robbins
authors.forename: J
authors.initials: J
authors.lastname: Miller
mesh_terms: D000328:Adult; D000368:Aged; D002140:California; D003376:Counseling; D005194:Family Practice / Q000592:standards*; D005260:Female; D006302:Health Services Research; D006304:Health Status; D006785:Hospitals, University; D006801:Humans; D007388:Internal Medicine / Q000592:standards*; D008297:Male; D008875:Middle Aged; D010044:Outpatient Clinics, Hospital / Q000592:standards*; D010358:Patient Participation; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D010818:Practice Patterns, Physicians' / Q000592:standards*; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D016896:Treatment Outcome