Samuel M. Putnam

The Medical Interview Satisfaction Scale: development of a scale to measure patient perceptions of physician behavior.

Patient satisfaction is a variable of increasing interest to researchers, clinicians, and medical educators. Of several studies reviewed, only a few have shown evidence of careful methodology. Most surveys have focused on general evaluations of doctors and/or health care services or of a particular facility. The present article reports the development of a scale to measure patient satisfaction with an encounter with a physician or other primary care provider. Methods of item generation and pretesting are detailed. The overall reliability of the scale (Cronbachs coefficientα) is 0.93. The distribution of satisfaction scores is broader than that reported for other scales and approaches the normal in shape. Clinical and research applications of the scale are suggested.

Interaction Exchange Structure and Patient Satisfaction with Medical Interviews

The verbal interaction between patients and physicians in 52 initial interviews in a university hospital screening clinic was studied using a new discourse coding system. Factor analysis of category frequencies showed that each interview segment, medical history, physical examination, and conclusion, consisted mainly of two or three types of verbal exchange. Patient satisfaction with the interviews, assessed with a questionnaire that yields separate scores for satisfaction with cognitive and affective aspects, was found to be associated with exchanges involving the transmission of information in particular interview segments. Affective satisfaction was associated with transmission of information from patient to physician in “exposition” exchanges during the medical history, in which patients told their story in their own words. Cognitive satisfaction was associated with transmission of information from physician to patient in “feedback” exchanges during the conclusion segment, in which physician gave patients information about illness and treatment.

The Validity of the Medical Record

The medical record is the source of information for many purposes, including evaluation of the quality of care provided. Despite this reliance on the record, there have been few attempts to validate the recorded content against the verbal content of the interaction between patient and physician. In this study, we compared the record with verbatim transcripts of outpatient visits. Overall, 59 per cent of units of information present in either source were found in the record. Recording was more complete for the chief complaint (92 per cent) and information related to the patients present illness (71 per cent) than for other medical history (29 per cent). Incomplete recording of elicited information may partially explain the often low levels of performance of recommended care items found in quality-of-care studies. We suggest that more attention be paid to improving communication about tests and therapies to patients.

Teaching the medical interview: an intervention study.

To study the effects of teaching specific interviewing techniques on verbal behaviors and on health outcomes, internal medicine residents working in a screening clinic were assigned to either an experimental or a control group. The entire clinic visit was audiotaped, transcribed, and coded according to the Verbal Response Mode (VRM) system. Residents in the experimental group were taught interviewing behaviors (patient exposition and physician explanation) that had been found in previous studies to be associated with patient outcomes. Through telephone interviews, patient satisfaction, compliance, and symptom status were determined for all patients. Two hundred and sixty-eight interviews (156 in the experimental group and 112 in the control group) were included in the study. Training did increase patient exposition and physician explanation, but did not affect health outcomes. Residents’ attitudes and behaviors during the training are described.

Dimensions of patient and physician roles in medical screening interviews

Abstract Social theorists have agreed that physicians are usually presumptuous and controlling while patients are usually deferent and acquiescent in medical encounters, but have disagreed about patient reaction to these reciprocal roles. One view has been that the status and power gap is bridged by a pattern of patient trust and physician attentiveness, while another view has been that patients become alienated as physicians use their control to maintain their institutionalized authority. These views were tested in a sample of 52 medical screening interviews with adults using an utterance-by-utterance coding system that yields scores on three dimensions in interpersonal roles, “attentiveness”, “acquiescence”, and “presumptuousness”. Coding yielded quantitative descriptions of patient-physician interaction that conformed closely to theoretical expectations. Patient satisfaction, assessed by a post-interview questionnaire, was positively correlated with physician acquiescence in the conclusion segment of the interview but not in the medical history or physical examination. Patients were also more satisfied when they expressed themselves in their own words during the medical history and when physicians were more informative in the conclusion segment. The results suggest possible refinements in current theoretical views of patient and physician roles.

VERBAL EXCHANGES IN MEDICAL INTERVIEWS: CONCEPTS AND MEASUREMENT

The verbal exchange theory of medical interviews (consultations) proposes that patients and clinicians employ a joint repertoire of exchanges to accomplish their goals in the encounter. The skeleton of each exchange is a set of speech acts that tend to be used together in interviews, for example, (a) clinician questions and patient yes/no answers, or (b) clinician directives and patient agreements to comply. We describe seven principal exchanges, each of which has been identified empirically in multiple studies of interviews: Exposition, Closed Question, Checking, Direction, Inquiry, Explanation, and Instruction/Contracts.

Coding Categories for Investigating Medical Interviews: A Meta Classification

Communication between patients and clinicians occurs in many different ways. Just as a patient’s cardiac function cannot be fully characterized by a single measure, the communication between clinician and patient cannot be fully described by a single coding system. Different measures may concern distinctly different aspects of the medical encounter. This chapter reviews some of the measures that have been used to characterize medical interactions. To organize the variety of coding categories and systems into an understandable framework, we used a metaclassification—a classification of classifications.