Communication patterns of primary care physicians

OBJECTIVES: To use audiotape analysis to describe communication\npatterns in primary care, to relate these to ideal relationship types as\ndescribed in the literature, and to explore the patterns' relationships with\nphysician and patient characteristics and satisfaction. DESIGN: Description of\nroutine communication in primary care based on audiotape analysis and patient\nand physician exit questionnaires. SETTING: A total of 11 ambulatory clinics\nand private practices. PARTICIPANTS: The participants were 127 physicians and\n537 patients coping with ongoing problems related to disease. MAIN OUTCOMES\nMEASURES: Roter Interactional Analysis System (RIAS) and patient and physician\nexit satisfaction questionnaires. RESULTS: Cluster analysis revealed 5\ndistinct communication patterns: (1) "narrowly biomedical," characterized by\nclosed-ended medical questions and biomedical talk occurring in 32% of visits;\n(2) "expanded biomedical," like the restricted pattern but with moderate\nlevels of psychosocial discussion occurring in 33% of the visits; (3)\n"biopsychosocial," reflecting a balance of psychosocial and biomedical topics\n(20% of the visits); (4) "psychosocial," characterized by psychosocial\nexchange (8% of visits); and (5) "consumerist," characterized primarily by\npatient questions and physician information giving (8% of visits). \nBiomedically focused visits were used more often with more sick, older, and\nlower income patients by younger, male physicians. Physician satisfaction was\nlowest in the narrowly biomedical pattern and highest in the consumerist\npattern, while patient satisfaction was highest in the psychosocial pattern. \nCONCLUSIONS: Primary care communication patterns range from narrowly\nbiomedical to consumerist patterns and parallel the ideal forms of\npatient-physician relationships described in the literature.