Cited by 939Patient-Provider Communication in HealthcarePrimary Care and Health OutcomesEmpathy and Medical Education

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Communication Patterns of Primary Care Physicians

Roter, Debra L.·1997·JAMA: The Journal of the American Medical Association

DOI 10.1001/jama.1997.03540280088045

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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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“By analogy Roter has reported [28] that consultations with a ‘‘consumerist’’ pattern (active patients asking questions and information-giving doctors) scored most highly on patientcenteredness, and also engendered doctor satisfaction.”
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“This is similar to the approach taken in several of our own studies (Roter et al., 1997; Wissow et al., 1998) and by other investigators (Ford, Fallowfield, & Lewis, 1996; Greenfield, Kaplan, & Ware, 1985; Mead & Bower, 2000).”
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“Patient satisfaction has been related to symptomatic improvement and functional status (Jackson et al., 2001), but also to doctors’ involvement, communication style, and empathic approach (Buckman, 1992; Roter et al., 1997).”
Background
Veterinarian-client-patient communication patterns used during clinical appointments in companion animal practice
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“5 The biomedical communication pattern reflects the paternalism model, with low patient control and input and high physician question-asking and verbal dominance.”
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“Despite this prevailing tendency in traditional medical education, data from a recent study on physician communication patterns (Roter et al., 1997) support that patient satisfaction is significantly higher in clinical encounters during which the physician practices a “psychosocial” communication pattern (i.”
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“This greater patient participation in an open relationship with the physician, in turn, is likely to contribute to greater relationship satisfaction among health-active consumers (Balint & Shelton, 1996; Laine & Davidoff, 1996; Roter et al., 1997; Street, 2001, 2003).”
Influential
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“Many of the targeted behaviors run counter to how people have been socialized to behave with regard to using health care (Roter et al., 1997).”
Background
Physician Strategies to Reduce Patients’ Out-of-pocket Prescription Costs
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Empowering communication: a community-based intervention for patients
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“Patient–physician communication is a critical element of high quality healthcare: it influences patients’ ability to recall physicians’ recommendations [1], achieve satisfaction [1–6], adhere to treatment regimens [1–3,5], and even achieve favorable biomedical health outcomes [7,8].”
Background
Survey Shows That At Least Some Physicians Are Not Always Open Or Honest With Patients
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Collective AIDS activism and individuals' perceived self-advocacy in physician-patient communication
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“On the other hand, we might find that it is the style of the physicians (e.g., paternalistic, authoritarian, or democratic) that determines the physicians’ reactions to patient attempts at participation (for a discussion of physician communication styles, see Kaplan, Greenfield, Gandek, Rogers, & Ware, 1996, or Roter…”
Background
Current perspectives on patient education in the US
ROTER, D. L., Stashefsky-Margalit, R., & Rudd, R. E. (2001) · Patient Education and Counseling · doi:10.1016/s0738-3991(01)00108-2 · Cited by 91
“Our own findings, however, generally find that that visits characterized by more patient-centered interviewing patterns were not significantly longer than other visits differing largely in content emphasis rather than duration of the visit [30].”
BackgroundResultSelf-citation

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
DOI: 10.1001/jama.1997.03540280088045
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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Communication Patterns of Primary Care Physicians

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