Physicians Build Less Rapport With Obese Patients
Physicians Build Less Rapport With Obese Patients
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DOI：
10.1002/oby.20384
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发表时间：
2013-10-01
期刊：
影响因子：
6.9
通讯作者：
Cooper, Lisa A.
中科院分区：
文献类型：
--
作者：
Gudzune, Kimberly A.;Beach, Mary Catherine;Cooper, Lisa A.
目的：医师对肥胖症患者的负面态度是有据可查的。这些信念是否或如何影响医患沟通尚不清楚。描述患者体重指数（BMI）与医生沟通行为的关系（生物医学，心理社会/生活方式，和融洽关系的建设）在典型的门诊初级保健访问的目的。设计和方法：使用来自39名城市初级保健医生（PCP）和208名患者的音频记录门诊就诊，使用Roter交互分析系统检查通信行为的频率。测量自变量;患者BMI和因变量是PCP在生物医学、社会心理/生活方式和融洽关系建立领域内的沟通行为。采用多水平Poisson回归模型进行横断面分析，以评估BMI与医生沟通之间的关系。结果：PCP与超重和肥胖患者的情感关系较差（发病率比，IRR，0.65，95% CI 0.48-0.88，P = 0.01; IRR0.69，95% CI 0.58-0.82，P < 0.01）。PCPs的生物医学或社会心理/生活方式的沟通，患者BMI.Conclusions：我们的研究结果提出的关注，低水平的情感融洽的超重和肥胖患者的初级保健访问可能会削弱患者与医生的关系，减少患者的依从性的建议，并降低行为改变咨询的有效性。
Objective: Physicians' negative attitudes toward patients with obesity are well documented. Whether or how these beliefs may affect patient-physician communication is unknown. To describe the relationship between patient body mass index (BMI) and physician communication behaviors (biomedical, psychosocial/ lifestyle, and rapport building) during typical outpatient primary care visits was aimed.Design and Methods: Using audio-recorded outpatient encounters from 39 urban primary care physicians (PCPs) and 208 of their patients, the frequency of communication behaviors using the Roter Interaction Analysis System was examined. The independent variable was measured; patient BMI and dependent variables were communication behaviors by the PCP within the biomedical, psychosocial/lifestyle, and rapport building domains. A cross-sectional analysis using multilevel Poisson regression models to evaluate the association between BMI and physician communication was performed.Results: PCPs demonstrated less emotional rapport with overweight and obese patients (incidence rate ratio, IRR, 0.65, 95% CI 0.48-0.88, P = 0.01; IRR 0.69, 95% CI 0.58-0.82, P < 0.01, respectively) than for normal weight patients. No differences in PCPs' biomedical or psychosocial/lifestyle communication by patient BMI were found.Conclusions: Our findings raise the concern that low levels of emotional rapport in primary care visits with overweight and obese patients may weaken the patient-physician relationship, diminish patients' adherence to recommendations, and decrease the effectiveness of behavior change counseling.