The DOI matches its Crossref record; 18 of the 18 references it cites were found in a registry or an index.
Communication Patterns of Primary Care Physicians
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.
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“Patients approached in the narrowly biomedical pattern (characterised by low amount of talk about psychosocial issues, high percentage of biomedical talk and a high percentage of question asking by the physician; low patient communication control; physician directed, guided) were more likely to be poorer (p<0.02)than patients approached in other patterns.(35)”
From Socio-economic status of the patient and doctor–patient communication: does it make a difference? (2005) · cites this paper as [35]
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“Studies of patient-centered care suggest significant benefits in terms of patient satisfaction and medical outcomes.110–114”
From Reducing Racial Bias Among Health Care Providers: Lessons from Social-Cognitive Psychology (2007) · cites this paper as [113]
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BackgroundRacial and Ethnic Differences in the Experience and Treatment of Noncancer Pain
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“The RIAS is a widely used coding system with demonstrated reliability and validity in studies of patient–physician communication [20–23].”
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Patient-Centered Decision Making and Health Care Outcomes: An Observational Study
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“Studies of PCC that attempted to show an association with outcomes have been disappointing (10–12).”
MethodInfluentialEngaging Health Care Consumers to Improve the Quality of Care
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The effects of communication skills training on patients' participation during medical interviews.
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“In this scheme, there are 3 communicative skills that physicians might use to facilitate cooperative history building and the patient’s telling of his or her illness narrative: (1) question-asking mindfulness, (2) organizational multitasking, and (3) use of conversational devices other than questions.”
BackgroundInfluentialPatient-reported Communication Quality and Perceived Discrimination in Maternity Care
Attanasio, L. B., & Kozhimannil, K. B. (2015) · Medical Care · doi:10.1097/mlr.0000000000000411 · Cited by 203
Cooper, L. A., ROTER, D. L., Carson, K. A., Bone, L., Larson, S. M., Miller, E. R., Barr, M. S., & Levine, D. M. (2011) · Journal of General Internal Medicine · doi:10.1007/s11606-011-1794-6 · Cited by 202
Self-citationCOMMUNICATION SKILLS FOR PATIENT-CENTERED CARE
Tongue, J. R., Epps, H. R., & Forese, L. L. (2005) · Journal of Bone and Joint Surgery · doi:10.2106/00004623-200503000-00027 · Cited by 199
Physician Gender Effects on Preventive Screening and Counseling
Henderson, J. T., & Weisman, C. S. (2001) · Medical Care · doi:10.1097/00005650-200112000-00004 · Cited by 199
Thornton, R. L. J., Powe, N. R., ROTER, D. L., & Cooper, L. A. (2011) · Patient Education and Counseling · doi:10.1016/j.pec.2011.07.015 · Cited by 218
“Older patients also tend to have an expectation that the patient–physician relationship should be more dominated by physician expertise that do younger patients, which also has implications for medical visit communication [26].”
BackgroundMethodSelf-citationManagement of chronic disease by practitioners and patients: are we teaching the wrong things?
Clark, N. M. (2000) · BMJ · doi:10.1136/bmj.320.7234.572 · Cited by 198
Howe, L. C., Goyer, J. P., & Crum, A. J. (2017) · Health Psychology · doi:10.1037/hea0000499 · Cited by 200
“, biomedical information) versus warmth-related features (e.g., discussing feelings and emotions; Roter et al., 1997), making these elements particularly important to understand for health care.”
BackgroundBurgess, D. J., van Ryn, M., Crowley‐Matoka, M., & Malat, J. (2006) · Pain Medicine · doi:10.1111/j.1526-4637.2006.00105.x · Cited by 200
Communication in Medical Encounters: An Ecological Perspective
Street, J. R. L. (2003) · doi:10.4324/9781410607683-9 · Cited by 192
Provider communication effects medication adherence in hypertensive African Americans
Schoenthaler, A., Chaplin, W. F., Allegrante, J. P., Fernandez, S., Diaz-Gloster, M., Tobin, J. N., & Ogedegbe, G. G. (2008) · Patient Education and Counseling · doi:10.1016/j.pec.2008.09.018 · Cited by 191
“Similarly, physicians tend to deliver less information and supportive talk to minority patients, as well as those of lower socioeconomic status [12, 13].”
BackgroundPatient-Physician Communication During Outpatient Palliative Treatment Visits
Detmar, S. B., Muller, M. J., Wever, L. D. V., Schornagel, J. H., & Aaronson, N. K. (2001) · JAMA · doi:10.1001/jama.285.10.1351 · Cited by 184
“Patients (n = 240) Mean age, y (range) 55 (24-84) Sex Male 27 Female 73 Marital status Single, divorced, widowed 21 Married 79 Education Primary school/lowerlevel high school 27”
BackgroundMast, M. S., Hall, J. A., & ROTER, D. L. (2007) · Patient Education and Counseling · doi:10.1016/j.pec.2007.03.020 · Cited by 186
“Patient-centered communication can be characterized by low physician dominance and high physician caring [13–16].”
BackgroundSelf-citationCOMMUNICATION BETWEEN OLDER PATIENTS AND THEIR PHYSICIANS
Adelman, R. D., Greene, M. G., & Ory, M. G. (2000) · Clinics in Geriatric Medicine · doi:10.1016/s0749-0690(05)70004-5 · Cited by 177
The evolving concept of “patient-centeredness” in patient–physician communication research
Ishikawa, H., Hashimoto, H., & Kiuchi, T. (2013) · Social Science & Medicine · doi:10.1016/j.socscimed.2013.07.026 · Cited by 172
Richardson, A. K., Allen, J. A., Xiao, H., & Vallone, D. (2012) · Journal of Health Care for the Poor and Underserved · doi:10.1353/hpu.2012.0181 · Cited by 168
Wissow, L. S., Roter, D., Bauman, L. J., Crain, E. F., Kercsmar, C., Weiss, K., Mitchell, H., & Mohr, B. (1998) · Medical Care · doi:10.1097/00005650-199810000-00002 · Cited by 150
Self-citationJung, H. P., Baerveldt, C., Olesen, F., Grol, R. P. T. M., & Wensing, M. (2003) · Health Expectations · doi:10.1046/j.1369-6513.2003.00221.x · Cited by 169
Shilling, V. M., Jenkins, V. A., & Fallowfield, L. J. (2003) · Psycho-Oncology · doi:10.1002/pon.731 · Cited by 171
“detecting psychological stress (Roter et al., 1997) breaking bad news (Maguire et al.”
BackgroundThe Importance of Medication Adherence in Improving Chronic-Disease Related Outcomes
Balkrishnan, R. (2005) · Medical Care · doi:10.1097/01.mlr.0000166617.68751.5f · Cited by 167
Reduction of Peripartum Racial and Ethnic Disparities
Howell, E. A., Brown, H. L., Brumley, J., Bryant, A., Caughey, A. B., Cornell, A., Grant, J., Gregory, K. D., Gullo, S. M., Kozhimannil, K. B., et al. (2018) · Obstetrics and Gynecology · doi:10.1097/aog.0000000000002475 · Cited by 167
Metadata
- Authors
- Roter, D. L.
- Affiliations
- Johns Hopkins University (US)
- Corresponding author
- Roter, Debra L.
- ORCID
- Roter, Debra L.
- Venue
- JAMA: The Journal of the American Medical Association
- Publisher
- American Medical Association (AMA)
- Published
- 1997-01-22
- Volume
- 277
- Issue
- 4
- Pages
- 350
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- OpenAlex
- W2029615977
- Cited by
- 939
- References
- 18
- Citations by year
- 2026: 4 · 2025: 20 · 2024: 9 · 2023: 16 · 2022: 18 · 2021: 35 · 2020: 24 · 2019: 29 · 2018: 29 · 2017: 41 · 2016: 23 · 2015: 41 · 2014: 28 · 2013: 38 · 2012: 53
- FWCI
- 48.64
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- JAMA (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Health Professions › General Health Professions › Patient-Provider Communication in Healthcare
- Health Sciences › Medicine › Family Practice › Primary Care and Health Outcomes
- Health Sciences › Medicine › Psychiatry and Mental health › Empathy and Medical Education
- Keywords
- physician-patient communication, primary care, communication patterns, biomedical communication, biopsychosocial care, patient satisfaction, physician satisfaction, physician-patient relationship, outpatient care, physician characteristics, patient characteristics
- MeSH terms
- Analysis of Variance, Communication, Family Practice, Humans, Physician-Patient Relations, Surveys and Questionnaires, Cluster Analysis, Patient Satisfaction, Personal Autonomy, Paternalism
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