TY - JOUR
T1 - Physician-patient communication following invasive procedures
T2 - An analysis of post-angiogram consultations
AU - Gordon, Howard S.
AU - Street, Richard L.
AU - Adam Kelly, P.
AU - Souchek, Julianne
AU - Wray, Nelda
N1 - Funding Information:
This research was in part at the 25th annual meeting of the Society of General Internal Medicine, May 2002, Atlanta. This research is based on work supported in part by a Career Development Award to Dr. Gordon, by Grant no. ECV 98 100 (PI-Gordon) from the Office of Research and Development, Health Services Research and Development Service, Department of Veterans Affairs, and by Grant no. P01 HS10876 from the Agency for Healthcare Research and Quality. At the time this work was conducted Drs. Gordon, Kelly, Souchek and Wray were employed in the Medical and Research Care Lines, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX. The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs.
PY - 2005/9
Y1 - 2005/9
N2 - Although rarely studied, physician-patient interactions immediately following diagnostic tests are significant medical events because during these encounters the physician and patient often make decisions about major and sometimes invasive treatment. This investigation analyzed patterns of physician-patient communication following coronary angiography with particular attention to behaviors important to decision-making: physician information-giving, physician use of partnership-building, and active forms of patient participation (e.g., asking questions, being assertive, expressing concerns). We were particularly interested in effects related to the patient's race in light of documented evidence of racial disparities in cardiac care and outcomes. From audiotape recordings, 93 physician-patient interactions after coronary angiogram in a catheterization laboratory in a large US Veterans Affairs Medical Center were coded to measure the frequency of physicians' information-giving and partnership-building and the frequency of active patient participation. We also stratified these behaviors according to whether the behavior was prompted (e.g., physician information in response to a patient's question; a patient's opinion solicited by the doctor) or self-initiated. Several findings were noteworthy. First, these interactions were very brief and dominated by the physician. Second, although physician information-giving increased with more active patient participation, which in turn was correlated with physicians' use of partnership-building, proportionally little of the physicians' information (8%) and active patient participation (9%) was directly prompted by the other interactant. Finally, there was a tendency for physicians to self-initiate less information giving to black patients and for black patients to self-initiate less active participation than white patients. Although these differences were attenuated when other variables (e.g., the physician's training, disease severity) were included in the analysis, the pattern suggests a potential cycle of passivity where certain patients tend to receive fewer informational resources and these patients in turn do less to prompt the doctor for more.
AB - Although rarely studied, physician-patient interactions immediately following diagnostic tests are significant medical events because during these encounters the physician and patient often make decisions about major and sometimes invasive treatment. This investigation analyzed patterns of physician-patient communication following coronary angiography with particular attention to behaviors important to decision-making: physician information-giving, physician use of partnership-building, and active forms of patient participation (e.g., asking questions, being assertive, expressing concerns). We were particularly interested in effects related to the patient's race in light of documented evidence of racial disparities in cardiac care and outcomes. From audiotape recordings, 93 physician-patient interactions after coronary angiogram in a catheterization laboratory in a large US Veterans Affairs Medical Center were coded to measure the frequency of physicians' information-giving and partnership-building and the frequency of active patient participation. We also stratified these behaviors according to whether the behavior was prompted (e.g., physician information in response to a patient's question; a patient's opinion solicited by the doctor) or self-initiated. Several findings were noteworthy. First, these interactions were very brief and dominated by the physician. Second, although physician information-giving increased with more active patient participation, which in turn was correlated with physicians' use of partnership-building, proportionally little of the physicians' information (8%) and active patient participation (9%) was directly prompted by the other interactant. Finally, there was a tendency for physicians to self-initiate less information giving to black patients and for black patients to self-initiate less active participation than white patients. Although these differences were attenuated when other variables (e.g., the physician's training, disease severity) were included in the analysis, the pattern suggests a potential cycle of passivity where certain patients tend to receive fewer informational resources and these patients in turn do less to prompt the doctor for more.
KW - Coronary angiography
KW - Coronary arteriosclerosis
KW - Patient characteristics
KW - Physician-patient communication
KW - USA
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U2 - 10.1016/j.socscimed.2004.12.021
DO - 10.1016/j.socscimed.2004.12.021
M3 - Article
C2 - 15955403
AN - SCOPUS:20444372663
VL - 61
SP - 1015
EP - 1025
JO - Social Science and Medicine
JF - Social Science and Medicine
SN - 0277-9536
IS - 5
ER -