Conversational Analysis of Interview by Resident Family Physicians

Park, Eal Whan

Abstract

BACKGROUND: Which component of physician's interviewing process affects the patient- physician relationship and clinical outcomes can be studied by videotaping conversations in an exam room. The purpose of this study was to record resident physicians' conversations, describe the frequency and the content of the observed patient- centered utterances in interviews, and analyze the correlation between the presence of observed patient- centered utterances and the level of satisfaction.
METHODS
Ten interactions for each of the 6 resident physicians were videotaped. The utterances of physicians were coded directly from video tapes and transcribed partially. Uttering to explore a patient's standpoint, uttering emotionally to mention directly about patient's feeling, and uttering to counsel a patient for coping skills were considered as indicators of patient- centered conversations.
RESULTS
The average number of physician's utterances per interaction was 32 (range 9~67). The mean time of an interaction was 8 minutes and 23 seconds (range: 1 min and 55 sec~20 min and 20 sec). Among the total 1,792 physicians' utterances, there were 29 social talks, 1,228 utterances for diagnosis, 376 utterances for treatment, 147 directive utterances, and 12 family-centered utterances. Among the utterances for diagnosis or treatment, there were 88 patient-centered utterances including 59 utterances for exploring a patient's standpoint, 23 emotional utterances, and 6 utterances for counseling. Fifty two patients responded to a questionnaire to assess satisfaction after an interaction. Sixteen respondents (30.8%) were very satisfied, 26 respondents (50.0%) were satisfied, 6 respondents (11.5%) were little satisfied, one respondent (1.9%) was unsatisfied, and 3 respondents (5.8%) were reserved to respond. There was no significant correlation between the presence of observed patient- centered utterances and the level of satisfaction (P>0.05).
CONCLUSION
Most of the resident physicians' utterances consisted of asking physician-centered questions and offering informations. The patient-centered utterances were observed 1~2 times per interaction in average, and they were brief. This study reveals that the presence of patient-centered utterances in interviews was not correlated with the level of patients' satisfaction.