title: Beliefs about control in the physician-patient relationship: effect on communication in medical encounters.
abstract: OBJECTIVE
  Effective communication is a critical component of quality health care, and to improve it we must understand its dynamics. This investigation examined the extent to which physicians' and patients' preferences for control in their relationship (e.g., shared control vs doctor control) were related to their communications styles and adaptations (i.e., how they responded to the communication of the other participant).
  
  
  METHODS
  Stratified case-controlled study.
  
  
  METHODS
  Twenty family medicine and internal medicine physicians and 135 patients.
  
  
  METHODS
  Based on scores from the Patient-Practitioner Orientation Scale, 10 patient-centered physicians (5 male, 5 female) and 10 doctor-centered physicians (5 male, 5 female) each interacted with 5 to 8 patients, roughly half of whom preferred shared control and the other half of whom were oriented toward doctor control. Audiotapes of 135 consultations were coded for behaviors indicative of physician partnership building and active patient participation.
  
  
  RESULTS
  Patients who preferred shared control were more active participants (i.e., expressed more opinions, concerns, and questions) than were patients oriented toward doctor control. Physicians' beliefs about control were not related to their use of partnership building. However, physicians did use more partnership building with male patients. Not only were active patient participation and physician partnership building mutually predictive of each other, but also approximately 14% of patient participation was prompted by physician partnership building and 33% of physician partnership building was in response to active patient participation.
  
  
  CONCLUSIONS
  Communication in medical encounters is influenced by the physician's and patient's beliefs about control in their relationship as well as by one another's behavior. The relationship between physicians' partnership building and active patient participation is one of mutual influence such that increases in one often lead to increases in the other.
authors.affiliation: Department of Communication, Texas A&M University, College Station, Tex 77843-4234, USA. r-street@tamu.edu
authors.forename: Richard L
authors.initials: RL
authors.lastname: Street
authors.forename: Edward
authors.initials: E
authors.lastname: Krupat
authors.forename: Robert A
authors.initials: RA
authors.lastname: Bell
authors.forename: Richard L
authors.initials: RL
authors.lastname: Kravitz
authors.forename: Paul
authors.initials: P
authors.lastname: Haidet
mesh_terms: D016022:Case-Control Studies; D003299:Cooperative Behavior; D005260:Female; D006801:Humans; D008297:Male; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D010819:Physician's Role / Q000523:psychology*; D010817:Physician-Patient Relations; D010821:Physicians, Family / Q000523:psychology; D035502:Trust / Q000523:psychology*