Two physician styles of focusing on the family.
BACKGROUND
Previous research has identified 2 styles of family physicians' focus on the patient's family: (1) using the family history as the context of care of the patient; and (2) maintaining a family orientation with the family as the unit of care. The purpose of our study was to determine whether these styles affect patient outcomes and time use during outpatient visits.


METHODS
In a cross-sectional study, data on 4454 outpatient visits to 138 community family physicians were collected using direct observation, patient and physician questionnaires, and medical record review. We computed partial correlations between the physician's family practice style score and patient outcomes for delivery of preventive services, patient visit satisfaction, and patient-reported delivery of specific components of primary care. We controlled for relevant patient characteristics.


RESULTS
The patients of the physicians using either practice style had similar levels of satisfaction with coordination of care and interpersonal communication, and their value of continuity of care was comparable. Patients of physicians with a family-history style, however, rated their physicians lower on a measure of in-depth knowledge of the patient and family but higher on preventive services delivery. Differences in time use during the visit reflected how these styles were manifested during the outpatient visit.


CONCLUSIONS
The different styles physicians use to focus on the family affect the process and outcomes of patient care. This difference may be explained by the developmental life cycle of family physicians, as younger physicians may be more focused on family history and older physicians may have a more family-oriented focus. Physicians may need to find alternate ways of meeting those patient needs not well met by their predominant practice style.
Medalie
J H
JH
Department of Family Medicine, The Ireland Cancer Center, Case Western Reserve University, Cleveland, OH 44106, USA.
Zyzanski
S J
SJ
Goodwin
M A
MA
Stange
K C
KC
D003430:Cross-Sectional Studies; D005190:Family; D005194:Family Practice / Q000458:organization & administration*; D005260:Female; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care; D010043:Outcome and Process Assessment, Health Care; D017060:Patient Satisfaction; D010821:Physicians, Family / Q000458:organization & administration; D010818:Practice Patterns, Physicians'; D011314:Preventive Health Services; D011368:Professional-Family Relations; D011787:Quality of Health Care