Patient contribution to the medical dialogue and perceived patient-centeredness. An observational study in Japanese geriatric consultations.
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.
Ishikawa
Hirono
H
Department of Hygiene & Public Health, Teikyo University School of Medicine, Tokyo, Japan. hirono-tky@umin.ac.jp
Hashimoto
Hideki
H
Roter
Debra L
DL
Yamazaki
Yoshihiko
Y
Takayama
Tomoko
T
Yano
Eiji
E
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