title: Patient contribution to the medical dialogue and perceived patient-centeredness. An observational study in Japanese geriatric consultations.
abstract: BACKGROUND
  Relatively few studies have directly addressed the interaction dynamics and consequences of a companion's presence in the medical visit, and their findings have been contradictory.
  
  
  OBJECTIVE
  To examine how patient's contribution to the medical dialogue, with or without the presence of a visit companion, is related to the perception of the medical visit as patient-centered.
  
  
  METHODS
  Observational study using pre- and postvisit questionnaires and audiotape recording of medical visits.
  
  
  METHODS
  One hundred and fifty-five patients aged 65 or over; 63 in medical visits that included the presence of a companion and 82 in visits that did not include a companion.
  
  
  METHODS
  Patient ratings of visit patient-centeredness.
  
  
  RESULTS
  Long visits (greater than 10 minutes long) and visits in which patients were verbally active were rated as more patient-centered by patients than other visits. Since patients were generally less verbally active in visits that included a companion, accompanied visits, especially if they were less than 10 minutes long, received lower patient-centered ratings than others. The presence of a companion was not related to length of the visit, suggesting that the verbal activity of the companion was off-set by decreased verbal activity of the patient.
  
  
  CONCLUSIONS
  Our results have suggested that patients are more likely to perceive their physician and visit as patient-centered when they have an opportunity to engage directly in the medical dialogue. A minimal amount of "talk-time" for patients themselves should be safeguarded even in a short visit, when a companion is present.
authors.affiliation: Department of Hygiene & Public Health, Teikyo University School of Medicine, Tokyo, Japan. hirono-tky@umin.ac.jp
authors.forename: Hirono
authors.initials: H
authors.lastname: Ishikawa
authors.forename: Hideki
authors.initials: H
authors.lastname: Hashimoto
authors.forename: Debra L
authors.initials: DL
authors.lastname: Roter
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Yamazaki
authors.forename: Tomoko
authors.initials: T
authors.lastname: Takayama
authors.forename: Eiji
authors.initials: E
authors.lastname: Yano
mesh_terms: D000368:Aged; D003142:Communication; D005853:Geriatrics / Q000706:statistics & numerical data*; D006801:Humans; D007564:Japan; D019370:Observation / Q000379:methods; D010817:Physician-Patient Relations; D011369:Professional-Patient Relations; D014789:Visitors to Patients