[Skip to Content]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address 54.197.124.106. Please contact the publisher to request reinstatement.
[Skip to Content Landing]
Article
January 22, 1997

Communication Patterns of Primary Care Physicians

Author Affiliations

From the Department of Health Policy and Management, the Johns Hopkins University School of Hygiene and Public Health, Baltimore, Md (Dr Roter); the Department of Family Practice, University of Western Ontario, London, Ontario (Dr Stewart); the Department of Medicine, Boston University Medical Center, Boston, Mass (Dr Putnam); the Department of Medicine, New York University Medical Center, New York (Dr Lipkin): Miami University, Oxford, Ohio (Dr Stiles); and Harvard University, Boston (Dr Inui).

JAMA. 1997;277(4):350-356. doi:10.1001/jama.1997.03540280088045
Abstract

Objectives.  —To use audiotape analysis to describe communication patterns in primary care, to relate these to ideal relationship types as described in the literature, and to explore the patterns' relationships with physician and patient characteristics and satisfaction.

Design.  —Description of routine communication in primary care based on audiotape analysis and patient and physician exit questionnaires.

Setting.  —A total of 11 ambulatory clinics and private practices.

Participants.  —The participants were 127 physicians and 537 patients coping with ongoing problems related to disease.

Main Outcomes Measures.  —Roter Interactional Analysis System (RIAS) and patient and physician exit satisfaction questionnaires.

Results.  —Cluster analysis revealed 5 distinct Communication patterns: (1) "narrowly biomedical," characterized by closed-ended medical questions and biomedical talk occurring in 32% of visits; (2) "expanded biomedical." like the restricted pattern but with moderate levels of psychosocial discussion occurring in 33% of the visits; (3) "biopsychosocial," reflecting a balance of psychosocial and biomedical topics (20% of the visits); (4) "psychosocial," characterized by psychosocial exchange (8% of visits); and (5) "consumerist," characterized primarily by patient questions and physician information giving (8% of visits). Biomedically focused visits were used more often with more sick, older, and lower income patients by younger, male physicians. Physician satisfaction was lowest in the narrowly biomedical pattern and highest in the consumerist pattern, while patient satisfaction was highest in the psychosocial pattern.

Conclusions.  —Primary care communication patterns range from narrowly biomedical to consumerist patterns and parallel the ideal forms of patient-physician relationships described in the literature.

×