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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MacInnes, D. L., Kinane, C., Beer, D., Parrott, J. M., Craig, T., Eldridge, S. M., Marsh, I., Krotofil, J., & Priebe, S. (2013) · Trials · doi:10.1186/1745-6215-14-257 · Cited by 8
Parental Expression of Emotions and Surgeon Responses During Consultations for Obstructive Sleep-Disordered Breathing in Children.
Leu, G. R., Links, A. R., Park, J., Beach, M., & Boss, E. (2021) · JAMA Otolaryngology - Head and Neck Surgery · doi:10.1001/jamaoto.2021.3530 · Cited by 6
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“To physicians, PCC facilitates their comprehension of medical information, promotes better identification of patient needs, perceptions, and expectations [21].”
Background
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Engel, K. G., Pedersen, K. S., Johansen, M. D., Schønnemann, K. R., Kjær, L. B., & Nayahangan, L. J. (2022) · Medical Teacher · doi:10.1080/0142159x.2022.2072280 · Cited by 8
Priorities of elderly dizzy patients in general practice
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“…physician is indisputable; physician empathy has been associated with reduced malpractice litigation (Levinson, 1994); better treatment adherence (Roter et al., 1997b); fewer physician burnouts (Roter et al., 1997a); decreased patient anxiety (Butow et al., 1997; Rietveld & Prins, 1998);…”
BackgroundInfluential
“How long does it take?” A mixed methods evaluation of computer-related work in GP consultations
Hayward, J., Buckingham, S. C., Thomson, F., Milne, H., Sheikh, A., Fernando, B., Cresswell, K. M., Williams, R., & Pinnock, H. (2015) · Journal of Innovation in Health Informatics · doi:10.14236/jhi.v22i4.95 · Cited by 8
“RIAS is an established validated tool 31 which divides the consultation into five over-arching stages (Table 1).”
Method
Treatment barriers among younger and older socioeconomically disadvantaged smokers.
Hammett, P. J., Fu, S. S., Burgess, D. J., Nelson, D. B., Clothier, B. A., Saul, J. E., Nyman, J. A., Widome, R., & Joseph, A. M. (2017) · PubMed · Cited by 8
Expectations and behaviour of older adults with neurological disorders regarding general practitioner consultations: an observational study
Schönenberg, A., Teschner, U., & Prell, T. (2021) · BMC Geriatrics · doi:10.1186/s12877-021-02469-3 · Cited by 8
“Interestingly, a subcomponent relating to empathetic psychosocial aspects, such as showing emotions and talking about mental well-being [54, 55], was linked to medical rather than social aspects.”
Background
Tussen paternalisme en consumentisme Het dilemma van de huisarts
Jung, H. P., Wensing, M., & Grol, R. P. T. M. (2001) · Huisarts en Wetenschap · doi:10.1007/bf03082318 · Cited by 8
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McNeilis, K. S. (2002) · Communication Studies · doi:10.1080/10510970209388600 · Cited by 9
“This is further supported by research which found that patients who communicated their concerns more clearly have the best chance of having their needs addressed immediately (Roter et al., 1997).”
Result
Power and powerlessness: GPs' narratives about lifestyle counselling
Abildsnes, E., Walseth, L. T., Flottorp, S. A., & Stensland, P. (2012) · British Journal of General Practice · doi:10.3399/bjgp12x630043 · Cited by 8
“36,37 Blaming patients who do .”
Can Some Clinicians Read Their Patients’ Minds? Or Do They Just Really Like People? A Communication and Relationship Study
Janisse, T., & Vuckovic, N. H. (2002) · Europe PMC (PubMed Central) · Cited by 8
Deliberative and Paternalistic Interaction Styles for Conversational Agents in Digital Health: Procedure and Validation Through a Web-Based Experiment
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Ethical and legal issues in the clinical practice of primary health care
Martínez-Romero, M. (2012) · Frontiers in Bioscience-Elite · doi:10.2741/e626 · Cited by 7
“Other work (59) explored the different communication patterns in primary care through audiotape analysis and questionnaires, and revealed 5 distinct communication patterns: narrowly biomedical, expanded biomedical, biopsychosocial, psychosocial and consumerist.”
Background
What Circumstances Prompt a Workplace Discussion in Medical Evaluations for Back Pain?
Shaw, W. S., Chin, E. H., Nelson, C. C., Rème, S. E., Woiszwillo, M. J., & Verma, S. K. (2012) · Journal of Occupational Rehabilitation · doi:10.1007/s10926-012-9392-y · Cited by 7
“In general, most patients prefer a balance between psychosocial and biomedical topics and the opportunity to ask questions [17].”
Background
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“E plays an important role in enhancing doctor–patient relationships, better handling of patients,[1] patient satisfaction, and clinical outcomes.[2] It is a cognitive model of understanding and involves understanding the feelings of others.”
Background
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Ørnes, K., Finset, A., Storøy, H.-L. E., & Pedersen, R. (2021) · Patient Education and Counseling · doi:10.1016/j.pec.2021.03.042 · Cited by 7
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“Intercoder agreement is calculated by double coding a randomly selected subset covering at least 10 % of the entire corpus [30, 31].”
Method
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“These racial and ethnic differences in communication are not inconsequential, because more patient-centered communication has been shown to be associated with better patient recall of information, higher satisfaction with care, and better health outcomes [45–47].”
Background
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Periodic Health Examinations and Missed Opportunities among Patients Likely Needing Mental Health Care
Stone, A., Hatfield, L. A., McLean, L., Tai‐Seale, M., Diamond, L. C., McGuire, T. G., Stults, C. D., Frankel, R. M., & Wilson, C. (2020) · PubMed · doi:10.17615/4kpc-ba72 · Cited by 7
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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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