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In an audiotape analysis of encounters between 127 physicians and 537 patients, Debra L. Roter, DrPH, a professor in the department of health policy and management at the Johns Hopkins School of Public Health in Baltimore, identified five distinct patterns of patient-physician communication.1 Physicians often used more than one pattern in different patient encounters, Roter notes. Here are the five patterns:
• Narrowly biomedical.
This pattern is characterized by technical and narrow exchanges having to do with physiological presentation of medical symptoms. Physicians dominate the conversation with closed-ended questions to patients and very little discussion of psychosocial issues. This pattern is associated with the lowest levels of both patient and physician satisfaction. Example: A patient comes in complaining of back pain. The doctor immediately asks, "Where exactly do you feel the pain? Does it hurt when you bend?"
• Expanded biomedical.
This pattern has a similar tone and focus as the narrowly biomedical with a modest increase (from 5% to 16% for physicians) in psychosocial talk. It may represent a transitional stage to an increase in the psychosocial dimension, Roter says. Example: Similar to above, but the doctor asks some open-ended questions: "How have you responded to pain medication?"
In this pattern, physicians ask fewer but more open-ended questions. Biomedical information is balanced with psychosocial discussions. The pattern is characterized by a more equal exchange and a greater patient voice than the biomedical patterns. This pattern also includes more social talk between physicians and patients. Example: The doctor opens the conversation further. "How have you been coping with the pain?"
A high level of psychosocial talk from both physicians and patients dominates this pattern. Physicians are largely responding to distress presented by the patients, and this pattern was associated with a higher diagnosis of psychosocial disorders. It was also associated with high patient satisfaction. Example: The doctor probes emotional aspects, such as depression or stress, but with fewer questions. "Your back pain must be making it more difficult for you to handle the kids."
Patients dominate this pattern by asking questions and seeking information from physicians. They are effectively using the physician as a technical consultant, Roter says. This method tends to be used by younger patients with higher levels of income and education. There is little psychosocial or social talk. This pattern is associated with the highest physician satisfaction. Example: The patient asks about a new pain medication, which is touted for its effectiveness with few side effects. The doctor renders an opinion.