Michele G. Greene

Older patient satisfaction with communication during an initial medical encounter

There has been extensive research on the factors associated with patient satisfaction with communication during medical encounters, however, little attention has been paid to satisfaction among subgroups of patients, including the elderly. It is inappropriate to assume that all patients have the same physician-patient relationship needs, and thus, they will all be satisfied with the same communication approaches during medical visits. In this study, we examine the interactional correlates of older patient satisfaction with an initial visit with a general internist. A multidisciplinary team composed of social scientists and physicians used the Multi-dimensional Interaction Analysis system to code audiotapes. Patients and physicians completed post-visit satisfaction questionnaires. Older patient satisfaction was positively correlated with the following variables: physician questioning and supportiveness on patient-raised topics; patient information-giving on patient-raised topics; the length of the visit; the physicians use of questions worded in the negative; shared laughter between the physician and the patient; and physician satisfaction. These findings suggest that older patients prefer encounters in which: (1) there is physician supportiveness and shared laughter; (2) they are questioned about and given an opportunity to provide information on their own agenda items; and (3) physicians provide some structure for the first meeting through their use of questions worded in the negative. The authors caution that although this sample of older patients appears to be satisfied with a communication style usually considered characteristic of the traditional model of the physician-patient relationship (i.e. a warm interpersonal style and physician-generated structure for the visit), older patients in other settings and future cohorts of elderly patients may prefer other communication approaches. It is also suggested that aspects of communication which provide satisfaction to patients in first visits may be different than aspects of communication associated with patient satisfaction in follow-up visits.

The Effects of the Presence of a Third Person on the Physician‐Older Patient Medical Interview

Objective: To compare communication in triadic (three‐person) and dyadic (two‐person) older patient medical interviews and to determine the influence of the presence of a third person on the physician‐older patient relationship.

COMMUNICATION BETWEEN OLDER PATIENTS AND THEIR PHYSICIANS

This article provides an overview of communication between older patients and their physicians. The authors discuss distinctive features of geriatric medical visits and empirical investigations of communication between physicians and older patients in real life clinical encounters highlighting the content, interactional processes, and outcomes of care. They also discuss strategies for improving communication between physicians and older patients using new and innovative technologies. The authors conclude that healing in its broadest sense can occur only through a humanistic approach to geriatric care.

Issues in Physician—Elderly Patient Interaction

The basis of an effective and satisfactory physician–patient relationship is found in the communication which occurs between these two individuals. By studying the interaction, we can learn much about the identities of the physician and patient, and how they view each other and the world. The interactional dynamics between physician and patient are unique. For example, even in initial medical encounters which involve the meeting of two strangers, patients and physicians deal with concerns as diverse as life and death as well as other intimate or personal issues. Researchers of physician–patient interaction seek to discover how communication evolves and how that communication reveals the multiple levels of meaning in the medical encounter.

Multi-dimensional interaction analysis: A collaborative approach to the study of medical discourse

This paper reviews the conceptual frameworks of several research approaches to the study of medical interactions. Two methods are discussed: process analysis and microanalysis. Adapted from Robert Baless study of the behavior of small groups, process analysis sorts and tallies such interviewing processes as questioning and informing, achieving analysis of large numbers of interviews at the expense of attention to the content or context of the interview. When used in medical interaction research, process analysis seeks correlation between processes documented in the interview and outcomes of the interview. The methods of conversation analysts and discourse analysts, microanalyses subject medical conversations to close linguistic study and contextualization. This review focuses on the underlying assumptions, generalizability of findings, and the types of subjective judgment applied by the methods. It then describes the Multi-Dimensional Interaction Analysis (MDIA) system, a linguistic analytic instrument that combines features of process analysis and microanalysis to capture content, process, and context of medical conversations. The MDIAs validity and reliability are reported and implications for future research are outlined.

Introduction to the Older Patient: A “First Exposure” to Geriatrics for Medical Students

In 2003, Weill Cornell Medical College developed a 4‐hour module to introduce the geriatric patient within the required first‐year doctoring course. The educational intervention highlights the importance of communication between older patients and physicians, the utility of an enhanced social history and functional assessment, and the pitfalls of ageism in the medical setting. The module incorporates film, the performing arts, and small‐group exposure to a community‐residing older person.

The Content of Physician and Elderly Patient Interaction in the Medical Primary Care Encounter

To examine the content of physician-elderly patient medical primary care encounters, audiotapes of 66 routine follow-up general medical visits were analyzed. Using the Multi-dimensional Interaction Analysis system, coders determined which content areas were discussed, which interactive participant initiated the discussion, and the quality of physician responsiveness in the different content areas. As hypothesized, physicians initiated discussion of the majority of subjects. Both physicians and patients were most likely to initiate discussion of medical topics. Physicians were more responsive to those topics that they initiated compared to the topics that older patients initiated. Implications of the research for physicians and elderly patients are discussed.

Discussion of Depression in Follow-Up Medical Visits with Older Patients

OBJECTIVES: To determine the frequency of discussion about depression in follow‐up medical visits of older patients, who initiates these discussions, the quality of responsiveness of physicians and patients in these discussions, and patient and physician characteristics that influence these discussions.

Hospital-based group practice

Initiation of a hospital-based faculty group practice to replace part of a general medical clinic was evaluated in a quasi-experimental design. Practice setting (where patients received their primary care) was the independent variable. The group practice, unlike the traditional clinic, emphasized primary care by providing 24-hour, seven day/week access by telephone; continuity between inpatient and ambulatory care (all patients admitted as private patients of group practice attending physicians) and coordination of care. Resource use, including visits to the primary care site, the emergency room and specialty clinics, and tests ordered at each site were tracked for one year by chart review. Multivariate analysis showed that, contrary to expectations, group practice patients had no fewer emergency room or specialty clinic visits, although they did make more visits to the practice. With respect to tests, practice patients had almost two more tests ordered in the primary care site than clinic patients, although there was no concomitant reduction in tests ordered at other sites. The authors conclude that ambulatory care resource use is an insufficient measure of the effect of a change in practice setting.