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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Background
The importance of psychosocial interventions and patient involvement in the treatment of schizophrenia
Tarrier, N., & Bobes, J. (2000) · International Journal of Psychiatry in Clinical Practice · doi:10.1080/13651500050518028 · Cited by 25
Discourse Features Among Providers, Patients, and Companions and Their Effect on Outcomes of Dementia Diagnosis Disclosure
Wynn, M. J., & Carpenter, B. D. (2017) · The Journals of Gerontology Series B · doi:10.1093/geronb/gbx154 · Cited by 24
“In the context of diagnostic feedback, providers naturally ask many questions and provide information and previous studies of other kinds of medical interactions with older adult patients have found similarly imbalanced speech (Roter et al., 1997; Schmidt et al., 2009).”
Background
Communication between Audiologist, Patient, and Patient’s Family Members during Initial Audiology Consultation and Rehabilitation Planning Sessions: A Descriptive Review
Manchaiah, V. K. C., Bellon-Harn, M. L., Dockens, A. L., Azios, J. H., & Harn, W. E. (2018) · Journal of the American Academy of Audiology · doi:10.3766/jaaa.18032 · Cited by 24
Analysis of pharmacist–patient communication using the Roter Method of Interaction Process Analysis System
Nakayama, C., Kimata, S., Oshima, T., Kato, A., & Nitta, A. (2015) · Research in Social and Administrative Pharmacy · doi:10.1016/j.sapharm.2015.05.007 · Cited by 23
Older Adults' Pain Communication During Ambulatory Medical Visits: An Exploration of Communication Accommodation Theory
Hehl, J. M., & McDonald, D. D. (2012) · Pain Management Nursing · doi:10.1016/j.pmn.2012.03.007 · Cited by 23
Creating a Transdisciplinary Research Center to Reduce Cardiovascular Health Disparities in Baltimore, Maryland: Lessons Learned
Cooper, L. A., Boulware, L. E., Miller, E. R., Golden, S. H., Carson, K. A., Noronha, G., Huizinga, M. M., ROTER, D. L., Yeh, H., Bone, L., et al. (2013) · American Journal of Public Health · doi:10.2105/ajph.2013.301297 · Cited by 25
Self-citation
Characteristics of outpatient clinical summaries in the United States
Salmon, C., O'Conor, R., Singh, S., Ramaswamy, R., Kannry, J., Wolf, M., & Federman, A. (2016) · Int. J. Medical Informatics · doi:10.1016/j.ijmedinf.2016.06.005 · Cited by 21
Patients’ and physicians’ perspectives and experiences on the quality of medical consultations: a qualitative study
Bahadori, M., Yaghoubi, M., HaghGoshyie, E., Ghasemi, M., & Hasanpoor, E. (2019) · International Journal of Evidence-Based Healthcare · doi:10.1097/xeb.0000000000000210 · Cited by 23
How breast cancer outpatients perceive mutual participation in patient-physician interactions.
Takayama, T., & Yamazaki, Y. (2004) · Patient Education and Counseling · doi:10.1016/s0738-3991(03)00092-2 · Cited by 25
“Because the length of a consultation necessarily affects the volume of observable behavior, some studies have attempted to control for effects related to duration by calculating the frequency of utterance types as a percentage of the consultation’s length or total number of utterances [17,21,22].”
Background
Unannounced Standardized Patient Assessment of the Roter Interaction Analysis System: The Challenge of Measuring Patient-Centered Communication
Weiner, S. J., Schwartz, A., Cyrus, K. D., Binns–Calvey, A., Weaver, F. M., Sharma, G., & Yudkowsky, R. (2012) · Journal of General Internal Medicine · doi:10.1007/s11606-012-2221-3 · Cited by 24
Is the communicative behavior of GPs during the consultation related to the diagnosis?
Deveugele, M. I., Derese, A., Bacquer, D. D., van den Brink-Muinen, A., Bensing, J. M., & Maeseneer, J. D. (2004) · Patient Education and Counseling · doi:10.1016/j.pec.2004.02.004 · Cited by 23
“determined communication patterns of general practitioners (GPs) [16].”
BackgroundMethod
Identification of nutrition communication styles and strategies: A qualitative study among Dutch GPs
van Dillen, S. M. E., Hiddink, G. J., Koelen, M. A., de Graaf, C., & van Woerkum, C. M. J. (2006) · Patient Education and Counseling · doi:10.1016/j.pec.2005.09.001 · Cited by 23
“[4] revealed five distinct communication styles, namely”
BackgroundResult
Supporting and resourcing treatment decision‐making: some policy considerations
Entwistle, V. A. (2000) · Health Expectations · doi:10.1046/j.1369-6513.2000.00087.x · Cited by 23
Evaluating shared decision‐making between companion animal veterinarians and their clients using the Observer OPTION 5 instrument
Janke, N., Coe, J. B., Sutherland, K. A., Bernardo, T. M., Dewey, C. E., & STONE, E. A. (2021) · Veterinary Record · doi:10.1002/vetr.778 · Cited by 25
Frequency of GP communication addressing the patient's resources and coping strategies in medical interviews: a video-based observational study
Mjaaland, T. A., & Finset, A. (2009) · BMC Family Practice · doi:10.1186/1471-2296-10-49 · Cited by 22
“Although several studies have documented the amount of psychosocial content of consultations, they have not specified how much of the psychosocial content is focused on patients' personal resources and coping behaviour rather than on their psychological distress and other problems [4, 5 ].”
Background
Predictors of Physicians' Attitudes Toward Sharing Information With Patients and Addressing Psychosocial Needs: A Cross-Sectional Study in Greece
Tsimtsiou, Z., Benos, A., Garyfallos, A. A., & Hatzichristou, D. G. (2011) · Health Communication · doi:10.1080/10410236.2011.578333 · Cited by 22
“However, conflicting findings have been reported about the influence of physicians’ age and sex (Audet et al., 2006; Krupat, Bell, Kravitz, Thom, & Azari, 2001; Roter et al., 1997), as well as socioeconomic class (Waitzkin, 1984) and relationship with religion (Hardart & Truog, 2003; Tsimtsiou et al.”
Background
Smart Patient, Smart Community: Improving Client Participation in Family Planning Consultations through a Community Education and Mass-Media Program in Indonesia
Kim, Y. M., Bazant, E., & Storey, J. (2006) · International Quarterly of Community Health Education · doi:10.2190/iq.26.3.d · Cited by 21
Assessment of Pharmacy Students' Communication Competence Using the Roter Interaction Analysis System During Objective Structured Clinical Examinations
Kubota, Y., Yano, Y., Seki, S., Takada, K., Sakuma, M., Morimoto, T., Akaike, A., & Hiraide, A. (2011) · American Journal of Pharmaceutical Education · doi:10.5688/ajpe75343 · Cited by 22
Psychometrics of shared decision making and communication as patient centered measures for two language groups.
Álvarez, K., Wang, Y., Alegria, M. M., Ault-Brutus, A., Ramanayake, N., Yeh, Y.-H., Jeffries, J. R., & Shrout, P. E. (2016) · Psychological Assessment · doi:10.1037/pas0000344 · Cited by 22
“Patients tend not to state their concerns or ask necessary questions during medical visits (Beisecker & Beisecker, 1990; Korsch, Gozzi, & Francis, 1968; Roter et al., 1997).”
Background
Decision-making and goal-setting in chronic disease management: Baseline findings of a randomized controlled trial
Kangovi, S., Mitra, N., Smith, R. A., Kulkarni, R., Turr, L., Huo, H., Glanz, K., Grande, D., & Long, J. A. (2016) · Patient Education and Counseling · doi:10.1016/j.pec.2016.09.019 · Cited by 22
“Patients of low socioeconomic status (SES) are less likely to receive patient-centered care: [1,2] providers tend to communicate with these patients in a narrowly biomedical, physiciandominated manner [3] characterized by low patient involvement in decision-making [4].”
Background
A Multicenter Comparison of Complementary and Alternative Medicine (CAM) Discussions in Oncology Care: The Role of Time, Patient-Centeredness, and Practice Context
Tilburt, J. C., Yost, K. J., Lenz, H., Zúñiga, M. L., O'Byrne, T. J., Branda, M. E., Leppin, A. L., Kimball, B. C., Fernandez, C., Jatoi, A., et al. (2019) · The Oncologist · doi:10.1634/theoncologist.2019-0093 · Cited by 22
Self-citation
An Investigation of the Relationship Between Health Literacy and Social Communication Skills in Older Adults
Hester, E. J. (2008) · Communication Disorders Quarterly · doi:10.1177/1525740108324040 · Cited by 22
Development and Validation of the Irritable Bowel Syndrome Satisfaction With Care Scale
Dorn, S. D., Morris, C. B., Wanta, S. E., Hopper, T. M., Hu, Y., Kelapure, R., Weinland, S. R., Norton, W. F., Norton, N. J., & Drossman, D. A. (2011) · Clinical Gastroenterology and Hepatology · doi:10.1016/j.cgh.2011.08.009 · Cited by 22
Assessment of the physician-caregiver relationship scales (PCRS).
Cox, E. D., Smith, M. A., Brown, R. L., & Fitzpatrick, M. (2008) · Patient Education and Counseling · doi:10.1016/j.pec.2007.08.004 · Cited by 24
“We began by evaluating an existing measure of physician or patient ‘‘relationship building’’ [16,19] based on the widely accepted Roter interaction analysis system (RIAS) [15–17,19,20,24–27] with confirmatory factor analysis (CFA).”
BackgroundMethodInfluential
Patient satisfaction with the information provided at a psychiatric emergency unit
Alexius, B., Berg, K., & Åberg-Wistedt, A. (2000) · Patient Education and Counseling · doi:10.1016/s0738-3991(99)00041-5 · Cited by 22
Orthopedic communication about osteoarthritis treatment: Does patient race matter?
Hausmann, L. R. M., Hanusa, B. H., Kresevic, D. M., Zickmund, S. L., Ling, B. S., Gordon, H. S., Kwoh, C. K., Mor, M. K., Hannon, M. J., Cohen, P. Z., et al. (2011) · Arthritis Care & Research · doi:10.1002/acr.20429 · Cited by 21
“Past studies, however, have found visits with African American patients to be more focused on biomedical issues (23,24) and less likely to contain rapport-building dialogue (28,29).”
Background
Mental Health Communications Skills Training for Medical Assistants in Pediatric Primary Care
Brown, J. D., Wissow, L. S., Cook, B. L., Longway, S., Caffery, E., & Pefaure, C. (2012) · The Journal of Behavioral Health Services & Research · doi:10.1007/s11414-012-9292-0 · Cited by 22
“A single coder analyzed all the videos after training to reliability on a different set of videos collected during a previous study.(47)”
Feasibility of an Internet-Based Intervention for Improving Diabetes Outcomes Among Low-Income Patients With a High Risk for Poor Diabetes Outcomes Followed in a Community Clinic
Ryan, J., Schwartz, R. S., Jennings, T. E., Fedders, M., & Vittoria, I. (2013) · The Science of Diabetes Self-Management and Care · doi:10.1177/0145721713484594 · Cited by 21
The priorities of elderly patients suffering from dizziness: A qualitative study
Kruschinski, C., Theile, G., Dreier, S. D., & Hummers, E. (2010) · European Journal of General Practice · doi:10.3109/13814780903479914 · Cited by 21
The development of a scale to discover outpatients’ perceptions of the relative desirability of different elements of doctors’ communication behaviours
Leckie, J., Bull, R. H. C., & Vrij, A. (2006) · Patient Education and Counseling · doi:10.1016/j.pec.2005.11.015 · Cited by 21
“In this respect, in order to cover a range of specific doctor communication behaviours the items in the scale relate to: (i) technical behaviour (questions 1 and 3, [23]), (ii) affective behaviours (questions 2 and 4, [2,6]), (iii) high doctor-controlling behaviours (questions 8 and 9, [2,24]), and (iv) low doctor-con…”
Background
Communication between South Asian patients and GPs: comparative study using the Roter Interactional Analysis System.
Neal, R. D., Ali, N., Atkin, K. M., Allgar, V. L., Ali, S., & Coleman, T. J. (2006) · PubMed Central · Cited by 21
The Influence of Medical Professional Knowledge on Empathy for Pain: Evidence From fNIRS
Xie, J., Yang, H., Xia, X., & Yu, S. (2018) · Frontiers in Psychology · doi:10.3389/fpsyg.2018.01089 · Cited by 21

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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