Shifts in doctor-patient communication between 1986 and 2002: a study of videotaped general practice consultations with hypertension patients.
Shifts in doctor-patient communication between 1986 and 2002: a study of videotaped general practice consultations with hypertension patients.
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DOI：
10.1186/1471-2296-7-62
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发表时间：
2006-10-25
影响因子：
2.9
通讯作者：
Schellevis FG
中科院分区：
文献类型：
--
作者：
Bensing JM;Tromp F;van Dulmen S;van den Brink-Muinen A;Verheul W;Schellevis FG
基于过去几十年患者已成为更积极的参与者以及医生变得更以任务为导向的假设，本研究试图确定1986年至2002年间全科医生（GP）与患者沟通模式的转变。
1986年和2002年进行了一项重复的横断面观察研究，采用了相同的方法。从两个现有的常规全科诊疗视频数据集当中，选取了高血压患者的诊疗案例（1986年有102例；2002年有108例）。全科医生和患者的沟通采用RIAS（罗特互动分析系统）进行编码。使用多层技术对数据进行了分析。
在两个研究阶段，患者群体之间均未发现性别或年龄差异。与预期相反，在近期的诊疗中患者不太积极，说话更少，提问更少，表现出的担忧也更少。全科医生提供了更多的医疗信息，但对患者病情表达担忧的频率也更低。此外，他们较少参与以过程为导向的行为以及建立合作关系。总体而言，这些结果表明2002年的诊疗比16年前更以任务为导向，更具事务性。
在全科医疗中存在一种更平等的关系，患者是积极且有批判性的消费者，这在这批高血压患者样本中未得到体现。多年来可以观察到的最重要的转变是全科医生的沟通模式朝着更具事务性、以任务为导向转变，这反映了近期对循证医学和规范化护理的重视。电脑进入诊疗室可能起到了一定作用。对于现代医学在帮助患者表达其担忧方面的有效性，可能会引发一些担忧。
Departing from the hypotheses that over the past decades patients have become more active participants and physicians have become more task-oriented, this study tries to identify shifts in GP and patient communication patterns between 1986 and 2002. A repeated cross-sectional observation study was carried out in 1986 and 2002, using the same methodology. From two existing datasets of videotaped routine General Practice consultations, a selection was made of consultations with hypertension patients (102 in 1986; 108 in 2002). GP and patient communication was coded with RIAS (Roter Interaction Analysis System). The data were analysed, using multilevel techniques. No gender or age differences were found between the patient groups in either study period. Contrary to expectations, patients were less active in recent consultations, talking less, asking fewer questions and showing less concerns or worries. GPs provided more medical information, but expressed also less often their concern about the patients' medical conditions. In addition, they were less involved in process-oriented behaviour and partnership building. Overall, these results suggest that consultations in 2002 were more task-oriented and businesslike than sixteen years earlier. The existence of a more equal relationship in General Practice, with patients as active and critical consumers, is not reflected in this sample of hypertension patients. The most important shift that could be observed over the years was a shift towards a more businesslike, task-oriented GP communication pattern, reflecting the recent emphasis on evidence-based medicine and protocolized care. The entrance of the computer in the consultation room could play a role. Some concerns may be raised about the effectiveness of modern medicine in helping patients to voice their worries.