Patients' health as a predictor of physician and patient behavior in medical visits - A synthesis of four studies
Patients' health as a predictor of physician and patient behavior in medical visits - A synthesis of four studies
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DOI：
10.1097/00005650-199612000-00006
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发表时间：
1996-12-01
期刊：
影响因子：
3
通讯作者：
Daltroy, LH
中科院分区：
文献类型：
--
作者：
Hall, JA;Roter, DL;Daltroy, LH
目标。尽管已知一些患者特征与医疗过程中医生和患者的沟通有关，但人们对患者健康状况对沟通过程的影响知之甚少。作者在四项原始研究中评估了患者的身体和情绪健康状况与医生和患者之间的言语和非言语沟通的关系，并使用荟萃分析程序将四项研究的结果结合起来。在四项关于常规门诊就诊的原始研究（由超过 250 名医生和超过 1,300 名患者组成）中，测量了健康状况，并对录音带或录像带记录进行了编码，以记录言语内容和非言语线索，表明医生和患者双方的任务相关行为和情感反应。以医生和/或患者为来源获得身体和心理健康数据；在两项研究中，还测量了医生对就诊的满意度。医生和患者的所有可用背景特征均通过部分相关性进行控制。使用的荟萃分析程序是未加权和加权（按样本大小）平均偏相关、跨研究的组合 P（Stouffer 方法）以及效应大小异质性检验。结果。医生对病情较重或情绪更加困扰的患者表现出负面反应的迹象，无论是在行为上还是在对就诊的满意度评分上。病情较重的患者也比健康的患者表现得更消极。然而，医生也对病情较重或更加痛苦的患者采取了各种积极且专业的适当行为。这种混合的反应模式是根据替代框架进行讨论的：医生的目标、情感的相互影响以及医生的矛盾心理。结论。患者的健康状况似乎会影响医患沟通。在临床实践中，医生对自己和患者行为的更多关注可能会增强诊断并防止误解。
OBJECTIVES. Although some patient characteristics are known to be related to physician and patient communication in medical encounters, very little is known about the impact of patients' health status on communication processes. The authors assess relations of patients' physical and emotional health status to verbal and nonverbal communication between physicians and patients in four original studies, and combine results across the four studies using meta-analytic procedures.METHODS. In four original studies of routine outpatient visits (consisting of more than 250 physicians and more than 1,300 patients), health status was measured and audiotape or videotape records were coded for verbal content and nonverbal cues indicating task-related behavior and affective reactions on the part of both the physician and the patient. Both physical and mental health data were obtained, using physicians and/or patients as sources; in two studies, physicians' satisfaction with the visit also was measured. All available background characteristics for both physicians and patients were controlled via partial correlations. The meta-analytic procedures used were the unweighted and weighted (by sample size) average partial correlations, the combined P across studies (Stouffer method), and the test of effect size heterogeneity.RESULTS. Physicians showed signs of negative response to sicker or more emotionally distressed patients, both in their behavior and in their ratings of satisfaction with the visit. Sicker patients also behaved more negatively than healthier patients. However, physicians also engaged in a variety of positive and professionally appropriate behaviors with the sicker or more distressed patients. This mixed pattern of responses is discussed in terms of alternative frameworks: the physician's goals, reciprocation of affect, and ambivalence on the part of the physician.CONCLUSIONS. The patient's health status appears to influence physician-patient communication. In clinical practice, increased attention by physicians to their own and their patients' behavior may enhance diagnosis and prevent misunderstandings.