Doctors' responses to patients' concerns: testing the use of sequential analysis.
OBJECTIVE
The aim of this small scale study was to explore interaction sequences during the medical consultation. Specific attention was paid to how doctors responded to patient's concerns and worries. Empathic behaviours (e.g. concern, partnership, legitimizing) and facilitating behaviours (e.g. paraphrasing, agreement) were considered as an adequate response to a patient's concern.


METHODS
Nine consultations of nine different GPs were randomly selected from a sample of 1600 videotaped doctor-patient consultations, that were all rated with the Roter Interaction Analysis System. Each consultation contained at least 9 utterances of patient's concern. It was investigated how doctors respond within five lags of utterances after a patient's concern.


RESULTS
The results showed that doctors more often responded to a patient's concern in a facilitative way than in an empathic way. When an empathic response was given, it appeared mostly during the first utterance after the patient expressed a concern.


CONCLUSIONS
The findings indicate that sequential analysis is appropriate to investigate a health care provider's specific style of responding. Based on the problems emerged during the sequential analysis, further exploration of the method is recommended.
van den Brink-Muinen
Atie
A
NIVEL (Netherlands Institute for Health Services Research), PO Box 1568, 3500 BN Utrecht, The Netherlands. a.vandenbrink@nivel.nl
Caris-Verhallen
Wilma
W
D001294:Attitude to Health; D003142:Communication; D006296:Health Services / Q000706:statistics & numerical data*; D006801:Humans; D010817:Physician-Patient Relations