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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Roter et al. found patients approached in narrowly biomedical pattern were more likely to be poorer (p<0.02) than patients in other patterns.
“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]
Studies of patient-centered care suggest significant benefits in terms of patient satisfaction and medical outcomes.
“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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Kee, J. W. Y., Khoo, H. S., Lim, I., & Koh, M. Y. H. (2017) · Health Professions Education · doi:10.1016/j.hpe.2017.03.006 · Cited by 230 · see citing works
Empathy and Patient–Physician Conflicts
Halpern, J. (2007) · Journal of General Internal Medicine · doi:10.1007/s11606-006-0102-3 · Cited by 226 · see citing works
“Finally, we have increasing evidence that physicians who engage emotionally enjoy their work more over time, which likely contributes to providing better care.(6,17,114) Medical training absent explicit training in handling negative emotions can lead to the deterioration of empathy.”
BackgroundSnyder, L., Leffler, C., & for the Ethics and Human Rights Committee, A. C. O. P. (2005) · Annals of Internal Medicine · doi:10.7326/0003-4819-142-7-200504050-00014 · Cited by 219 · see citing works
Beach, M. C., ROTER, D. L., Wang, N., Duggan, P. S., & Cooper, L. A. (2006) · Patient Education and Counseling · doi:10.1016/j.pec.2006.06.004 · Cited by 217 · see citing works
“The RIAS is a widely used coding system with demonstrated reliability and validity in studies of patient–physician communication [20–23].”
MethodSelf-citationNgui, E. M., & Flores, G. (2006) · PEDIATRICS · doi:10.1542/peds.2005-1088 · Cited by 215 · see citing works
Patient-Centered Decision Making and Health Care Outcomes: An Observational Study
Weiner, S. J., Schwartz, A., Sharma, G., Binns-Calvey, A., Ashley, N., Kelly, B., Dayal, A., Patel, S., Weaver, F. M., & Harris, I. (2013) · Annals of Internal Medicine · doi:10.7326/0003-4819-158-8-201304160-00001 · Cited by 212 · see citing works
“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
Hibbard, J. H. (2003) · Medical Care · doi:10.1097/00005650-200301001-00007 · Cited by 211 · see citing works
The effects of communication skills training on patients' participation during medical interviews.
Cegala, D., McClure, L., Marinelli, T. M., & Post, D. M. (2000) · Patient Education and Counseling · doi:10.1016/s0738-3991(00)00093-8 · Cited by 218 · see citing works
Physicians’ opening questions and patients’ satisfaction
Robinson, J. D., & Heritage, J. C. (2006) · Patient Education and Counseling · doi:10.1016/j.pec.2005.11.009 · Cited by 209 · see citing works
“We used the Socioemotional Behavior subscale of the Medical Interview Satisfaction Scale because it is arguably the most common, longstanding, and well validated measure of patients’ evaluations of the affective/relational dimension of physicians’ communication [39].”
MethodStreet, R. L. (2002) · Patient Education and Counseling · doi:10.1016/s0738-3991(02)00171-4 · Cited by 204 · see citing works
“[9] recently observed that, although doctors generally exhibited more than one pattern of communication (e.”
Background"Building" a History Rather Than "Taking" One
Haidet, P., & Paterniti, D. A. (2003) · Archives of Internal Medicine · doi:10.1001/archinte.163.10.1134 · Cited by 206 · see citing works
“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 · see citing works
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 · see citing works
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 · see citing works
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 · see citing works
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 198 · see citing works
“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 · see citing works
Howe, L. C., Goyer, J. P., & Crum, A. J. (2017) · Health Psychology · doi:10.1037/hea0000499 · Cited by 193 · see citing works
“, 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 193 · see citing works
Communication in Medical Encounters: An Ecological Perspective
Street, J. R. L. (2003) · doi:10.4324/9781410607683-9 · Cited by 192 · see citing works
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 · see citing works
“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 · see citing works
“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 183 · see citing works
“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 · see citing works
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 · see citing works
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 · see citing works
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 · see citing works
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 · see citing works
Shilling, V. M., Jenkins, V. A., & Fallowfield, L. J. (2003) · Psycho-Oncology · doi:10.1002/pon.731 · Cited by 171 · see citing works
“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 · see citing works
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 · see citing works
- 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 › Health Professions › General Health Professions › 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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