Outcome-based doctor-patient interaction analysis

II. Identifying effective provider and patient behavior

William B. Carter, Thomas Inui, Walter A. Kukull, Virginia H. Haigh

Research output: Contribution to journalArticle

141 Citations (Scopus)

Abstract

Three interactional analysis (IA) systems (Bales’, Roter’s modified Bales and Stiles’ “Verbal response modes”) were used to characterize behavioral elements of provider-patient dialogues of 101 new-patient visits in a general medical clinic. In a previous article, 1 the explanatory power of these IA systems was compared. In this article, specific provider and patient behaviors within segments of the encounter (introduction-history, physical examination and conclusion), which were shown to be related to encounter outcomes of knowledge, compliance and satisfaction, were examined. Review of interactional behaviors entering regression analysis with a significant F-to-enter (p 3=0.05) and supplementary contextual analyses suggested the importance of several categories of physician and patient behavior. Behaviors manifesting tension bear important and complex relationships to encounter outcomes. For example, patient and physician expressions of tension generally bear strong negative relationships to patient satisfaction, while patient expressions interpreted as tension release are positively related to both satisfaction and compliance. The timing of other behaviors appears to be critical to subsequent outcomes. If patient requests for medication occur early in the encounter, this behavior is positively related to subsequent patient satisfaction. However, if they occur in the concluding segment, a negative relationship results. Finally, several relationships taken together indicate that physician teaching in the concluding segment may be important. While useful observations may emerge from application of currently available IA techniques, the resulting information is best characterized as hypothesis-generating. These IA systems have many limitations, and research is needed to derive more clinically oriented systems that may permit more consistent demonstrations of critical process-outcome relationships.

Original languageEnglish (US)
Pages (from-to)550-566
Number of pages17
JournalMedical Care
Volume20
Issue number6
StatePublished - 1982
Externally publishedYes

Fingerprint

systems analysis
interaction
physician
Physicians
Patient Satisfaction
Compliance
behavior analysis
regression analysis
medication
dialogue
Physical Examination
examination
Teaching
History
Regression Analysis
history
Research

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Nursing(all)
  • Health(social science)
  • Health Professions(all)

Cite this

Outcome-based doctor-patient interaction analysis : II. Identifying effective provider and patient behavior. / Carter, William B.; Inui, Thomas; Kukull, Walter A.; Haigh, Virginia H.

In: Medical Care, Vol. 20, No. 6, 1982, p. 550-566.

Research output: Contribution to journalArticle

Carter, William B. ; Inui, Thomas ; Kukull, Walter A. ; Haigh, Virginia H. / Outcome-based doctor-patient interaction analysis : II. Identifying effective provider and patient behavior. In: Medical Care. 1982 ; Vol. 20, No. 6. pp. 550-566.
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