Patient participation in the medical specialist encounter: does physicians' patient-centred communication matter?
OBJECTIVE
Physicians' patient-centred communication is assumed to stimulate patients' active participation, thus leading to more effective and humane exchange in the medical consultation. We investigated the relationship between physicians' patient-centred communication and patient participation in a medical specialist setting.


METHODS
Participants were 30 residents and specialists in internal medicine, and 323 of their patients. Participants completed a questionnaire prior to a (videotaped) follow-up consultation. Physicians' patient-centred communication was assessed by coding behaviours that facilitate or rather inhibit patients to express their perspective. Patient participation was determined by assessing (a) their relative contribution to the conversation, and (b) their active participation behaviour. Analyses accounted for relevant background characteristics.


RESULTS
Physicians' facilitating behaviour was found to be positively associated with patients' relative contribution to the conversation as well as patients' active participation behaviour. Physicians' inhibiting behaviour was not related to patients' relative contribution, and was, unexpectedly, positively associated with patients' active participation behaviour. Physicians' behaviour was particularly associated with patients' expression of concerns and cues.


CONCLUSIONS
Physicians in internal specialist medicine appear to be able to facilitate patients' active participation in the visit. The findings indicate that inhibiting behaviour may not have the expected blocking effect on patient participation: patients voiced their perspectives just the same and expressed even more concerns. Showing inhibiting behaviour may, alternatively, be a physician's response to the patient's increased participation in the encounter.


CONCLUSIONS
The results may give directions for future medical education and specialist training.
Zandbelt
Linda C
LC
Department of Medical Psychology, Academic Medical Center/University of Amsterdam, The Netherlands. L.C.Zandbelt@amc.uva.nl
Smets
Ellen M A
EM
Oort
Frans J
FJ
Godfried
Mieke H
MH
de Haes
Hanneke C J M
HC
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001242:Assertiveness; D001291:Attitude of Health Personnel; D003142:Communication; D003463:Cues; D004645:Empathy; D005260:Female; D006801:Humans; D007388:Internal Medicine / Q000458:organization & administration*; D008297:Male; D008875:Middle Aged; D008960:Models, Psychological; D009426:Netherlands; D010358:Patient Participation / Q000379:methods / Q000523:psychology*; D018802:Patient-Centered Care / Q000458:organization & administration*; D010819:Physician's Role / Q000523:psychology; D010817:Physician-Patient Relations; D012944:Social Support; D011795:Surveys and Questionnaires; D014743:Videotape Recording