Patient cues and medical interviewing in general practice: examples of the application of sequential analysis.
OBJECTIVE
To illustrate how sequence analysis may be applied to the medical interview to: 1. explore how physicians without formal training in communication skills elicit and respond to patient cues and expression of expectations and opinions; and 2. test the hypothesis that physicians' closed ended questions determine the use of subsequent closed ended questions.


METHODS
238 consultations in primary care, coded with the Verona Medical Interview Classification System, were analysed. Lag 1 analysis was applied to study which physician behaviour precedes and follows patient cues. Pattern recognition analysis for five lag sequences was performed to test the occurrence of predefined specific code chains, where a closed and an open ended question were followed either by two closed-ended questions or by two patient facilitating interventions


RESULTS
Patients' cue offers were most likely after facilitative interventions, but not after open-ended questions; physicians were most likely to respond to these expressions with facilitation. Physicians' tendency to use closed ended questions increased after previous closed questions and decreased after an open-ended question.


CONCLUSIONS
Lag sequential analysis and pattern recognition analysis are useful methods to study exploratory and theory driven hypotheses and allow an initial approach to validate the supposed appropriateness of specific physician interventions.
Zimmermann
Christa
C
Department of Medicine and Public Health, Section of Psychiatry, Service of Medical Psychology, University of Verona, Policlinico G.B. Rossi, Piazzale L.A. Scuro 10, 37134 Verona, Italy. christa.zimmermann@univr.it
del Piccolo
Lidia
L
Mazzi
Maria Angela
MA
D003142:Communication; D003463:Cues; D006296:Health Services / Q000706:statistics & numerical data*; D006801:Humans; D010817:Physician-Patient Relations; D011320:Primary Health Care; D011795:Surveys and Questionnaires