Beliefs about control in the physician-patient relationship
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
OBJECTIVES: Effective communication is a critical component of quality health care, and to improve it we must understand its dynamics. This investigation examined the extent to which physicians’ and patients’ preferences for control in their relationship (e.g., shared control vs doctor control) were related to their communications styles and adaptations (i.e., how they responded to the communication of the other participant).
DESIGN: Stratified case-controlled study.
PATIENTS/PARTICIPANTS: Twenty family medicine and internal medicine physicians and 135 patients.
MEASUREMENTS: Based on scores from the Patient-Practitioner Orientation Scale, 10 patient-centered physicians (5 male, 5 female) and 10 doctor-centered physicians (5 male, 5 female) each interacted with 5 to 8 patients, roughly half of whom preferred shared control and the other half of whom were oriented toward doctor control. Audiotapes of 135 consultations were coded for behaviors indicative of physician partnership buidling and active patient participation.
MAIN RESULTS: Patients who preferred shared control were more active participants (i.e., expressed more opinions, concerns, and questions) than were patients oriented toward doctor control. Physicians’ beliefs about control were not related to their use of partnership building. However, physicians did use more partnership building with male patients. Not only were active patient participation and physician partnership building mutually predictive of each other, but also approximately 14% of patient participation was prompted by physician partnership building and 33% of physician partnership building was in response to active patient participation.
CONCLUSIONS: Communication in medical encounters is influenced by the physician’s and patient’s beliefs about control in their relationship as well as by one another’s behavior. The relationship between physicians’ partnership building and active patient participation is one of mutual influence such that increases in one often lead to increases in the other.
- Stewart M. Effective physician-patient communication and health outcomes: a review. Can Med J. 1995;152:1423–33.
- Rost KM, Carter W, Inui T. Introduction of information during the initial medical visit: consequences for patient follow-through with physician recommendations for medication. Soc Sci Med. 1989;28:315–21. CrossRef
- Kaplan SH, Greenfield S, Ware JE Jr. Assessing the effects of physician-patient interactions on the outcomes of chronic disease. Med Care. 1989;27(suppl):110–27. CrossRef
- Roter DL, Hall JA. Doctors Talking to Patients/Patients Talking to Doctors. Westport, Conn: Auburn House; 1993.
- Street RL Jr. Active patients as powerful communicators. In: Robinson WP, Giles H, eds. The New Handbook of Language and Social Psychology. Chichester, UK: John Wiley; 2001:541–60.
- Giles H, Street RL Jr. Communicator characteristics and behavior. In: Miller GR, Knapp M, eds. Handbook of Interpersonal Communication, 2nd ed. Newbury Park, Calif: Sage Publication; 1994:103–61.
- Levenstein JH, Brown JB, Weston WW, Stewart M, McCracken EC, McWhinney I. Patient-centered clinical interviewing. In: Stewart M, Roter D, eds. Communicating with Medical Patients. Newbury Park, Calif: Sage Publications; 1989:107–20.
- Stewart M, Brown JB, Weston WW, McWhinney IR, McWilliam CL, Freeman TR. Patient-centered Medicine: Transforming the Clinical Method. Thousand Oaks, Calif: Sage Publications; 1995.
- Roter DL, Stewart M, Putnam SM, Lipkin M, Stiles W, Inui TS. Communication patterns of primary care physicians. JAMA. 1997;227:350–6. CrossRef
- Street RL Jr. Information-giving in medical consultations: the influence of patients’ communicative styles and personal characteristics. Soc Sci Med. 1991;32:541–8. CrossRef
- Street RL Jr. Communicative styles and adaptations in physician-parent consultations. Soc Sci Med. 1992;34:1155–63. CrossRef
- Roter DL, Hall JA, Aoki Y. Physician gender effects in medical communication: a meta-analytic review. JAMA. 2002;288:756–64. CrossRef
- Krupat E, Rosenkranz SL, Yeager CM, Barnard K, Putnam SM, Inui TS. The practice orientations of physicians and patients: the effect of doctor-patient congruence on satisfaction. Patient Educ Couns. 2000;39:49–59. CrossRef
- Haidet P, Dains JE, Paterniti DA, Chang T, Tseng E, Rogers JC. Medical students’ attitudes toward patient-centered care and standardized patients’ perceptions of humanism: a link between attitudes and outcomes. Acad Med. 2002;76(10 suppl):42–4.
- Roter D, Lipkin M, Korsgaard A. Sex differences in patients’ and physicians’ communication during primary care medical visits. Med Care. 1991;29:1083–93. CrossRef
- Krupat E, Bell RA, Kravitz RL, Thom D, Azari R. When physician and patients think alike: patient-centered beliefs and their impact on satisfaction and trust. J Fam Pract. 2001;50:1057–62.
- Degner LF, Sloan J. A. Decision-making during serious illness: what role do patients really want to play? J Clin Epidemiol. 1992;45: 941–50. CrossRef
- Benbassat J, Tidhar M. Patients’ preferences for participation in clinical decision-making: a review of published surveys. Behav Med. 1998;24:81–8. CrossRef
- Beisecker AE, Beisecker TD. Patient information-seeking behaviors when communicating with doctors. Med Care. 1990;28:19–28. CrossRef
- Cox A. Eliciting patients’ feelings. In: Stewart M, Roter D, eds. Communicating with Medical Patients. Newbury Park, Calif: Sage Publications; 1989:99–106.
- Wissow LS, Roter D, Wilson MEH. Pediatrician interview style and mothers’ disclosure of psychosocial issues. Pediatrics. 1994;93:289–95.
- Kravitz RL, Bell RA, Azari R, Krupat E, Kelly-Reif S, Thom D. Request fulfillment in office practice: antecedent and relationships to outcomes. Med Care. 2002;40:38–51. CrossRef
- Ben-Sira Z. Affective and instrumental components of the physician patient relationship: an additional dimension of interaction theory. J Health Soc Behav. 1980;21:170–80. CrossRef
- Krupat E, Putnam SM, Yeager C. The fit between doctors and patients: can it be measured? J Gen Intern Med. 1996;11(suppl):134.
- Street RL Jr, Millay B. Analyzing patient participation in medical encounters. Health Commun. 2001;13:61–73. CrossRef
- Street RL Jr, Piziak V, Carpentier W, et al. Provider-patient communication and metabolic control. Diabetes Care. 1993;16: 714–21. CrossRef
- Roter DL, Hall JA, Katz NR. Patient-physician communication: a descriptive summary of the literature. Patient Educ Couns. 1998;12:99–119. CrossRef
- Singer J. Using SAS PROC MIXED to fit multilevel models, hierarchical models, and individual growth models. J Educational Behav Stat. 1998;24:323–55. CrossRef
- Henbest RJ, Stewart MA. Patient-centeredness in the consultation 2: does it really make a difference? Fam Pract. 1990;7:28–33. CrossRef
- McGee DS, Cegala DJ. Patient communication skills training for improved communication competence in the primary care medical consultation. J Applied Commun Res. 1998;26:412–30. CrossRef
- Anderson LA, DeVellis BM, DeVellis RF. Effects of modeling on patient communication, satisfaction, and knowledge. Med Care. 1987;25:1044–56. CrossRef
- Street RL Jr, Voigt B, Geyer C, Manning T, Swanson G. Increasing patient involvement in deciding treatment for early breast cancer. Cancer. 1995;76:2275–85. CrossRef
- Greenfield S, Kaplan S, Ware JE Jr. Expanding patient involvement in care. Ann Intern Med. 1985;102:520–8.
- Street RL Jr. Interpersonal communication skills in health care contexts. In: Greene JO, Burleson BR, eds. Handbook of Communication and Social Interaction Skills. Mahwah, NJ: Erlbaum; 2003:909–33.
- Levinson W, Roter D. The effects of two continuing medical education programs on communication skills of practicing primary care physicians. J Gen Intern Med. 1993;8:318–24. CrossRef
- Roter DL, Hall JA, Kern DE, Barker LR, Cole KA, Roca RP. Improving physicians’ interviewing skills and reducing patients’ emotional distress: a randomized clinical trial. Arch Intern Med. 1995;155:1877–84. CrossRef
- Henbest RJ, Fehrsen GS. Patient-centeredness: is it applicable outside the West? Fam Pract. 1992;9:311–7. CrossRef
- Beliefs about control in the physician-patient relationship
Journal of General Internal Medicine
Volume 18, Issue 8 , pp 609-616
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- physician-patient communication
- patient participation
- Industry Sectors
- Author Affiliations
- 1. Department of Communication, TAMU 4234, Texas A&M University, 77843-4234, College Station, TX
- 2. Department of Psychology, Health Psychology Program, Massachusetts College of Pharmacy and Health Sciences, Boston, Mass
- 3. Department of Communication, University of California-Davis, Davis, Calif
- 4. Department of Medicine and UC Davis Center for Health Services Research in Primary Care, University of California-Davis, Davis, Calif
- 5. Department of Medicine, The Houston Center for Quality of Care and Utilization Studies at the Houston Veterans Affairs Medical Center and Baylor College of Medicine, Houston, Tex