Information Exchange in a Patient-Physician Encounter. A Quantitative Approach

Abstract:

The efficiency of data acquisition in a patient-physician encounter was investigated. In a simulation study, in which 60 family physicians and eight internists participated, the patient was replaced by an actor who used a structured set of patient data. The simulation model proved to be quite natural; data acquisition was primarily influenced by the amount of time available. Discerning between overall and diagnostic information, conclusions could be drawn on the effectiveness of data acquisition. Under time pressure, physicians tend to look for broadly defined symptoms rather than for details of the patient’s illness. The collection of patient data then has an inquisitive character, having implications for the quality of clinical judgement. The physician’s capabilities in eliciting relevant information from a patient appear to be of crucial importance for clinical problem-solving. The present study shows that patient-physician interviewing is effective insofar it concerns broad descriptions, but ineffective in eliciting specific data. If interviewing is laborious and time-consuming this may, therefore, affect the kind of information to be collected.

Key-Words

General Practice - Patient Interview - Simulation

• REFERENCES

• 1 Byrne PS, Long BEL. Doctors Talking to Patients. London: HMSO; 1978
• 2 Davis MS. Variations in patients’ compliance with doctors’ advice: an empirical analysis of patterns of communication. Am J Public Health 1968; 58: 274-88.
• 3 Lloyd M. Medical authoritarianism and its effect on health care. Med J Aust 1974; 02: 413-6.
• 4 Pendleton D, Hasler J. Doctor-Patient Communication. New York: Academic Press; 1983
• 5 Kohle K, Raspe HH. Das Gesprach wahrend der arztlichen Visite. Munich: Urban and Schwarzenberg; 1982. (in German).
• 6 Cassell EJ. Talking with Patients. Vol I: The Theory of Doctor-Patient Communication. Cambridge Mass: MIT Press; 1985
• 7 Coulthard M, Ashby M. Talking with the doctor. J Commun 1975; 25: 140-7.
• 8 Mishler EG. The Discourse of Medicine: Dialectics of Medical Interviews. Norwood NJ: Ablex Publ Corp; 1984
• 9 Elstein AS, Shulman LS, Sprafka S. Medical Problem Solving. Cambridge Mass: Harvard Univ Press; 1978
• 10 Ridderikhoff J. Medical problem solving: an exploration of strategies. Med Educ 1991; 25: 196-207.
• 11 Ridderikhoff J. The paper patent. In: Sheldon MG, Brooke J, Rector A. (eds). Decision Making in General Practice. Hounslow: McMillan; 1985
• 12 Engel GL. The clinical application of the biopsychosocial model. Am J Psychiatry 1980; 137: 535-44.
• 13 Weinberg GM. An Introduction to General Systems Thinking. New York: Wiley; 1975
• 14 Dudley HAF, Blanchard EB. Comparison of experienced and inexperienced interviewers on objectively scored interview behavior. J Clin Psychol 1976; 32: 690-7.
• 15 Barrows HS, Feltovich PJ. The clinical reasoning process. Med Educ 1987; 21: 86-91.
• 16 Ridderikhoff J. Methods in Medicine. Dordrecht: Kluwer Acad Publ; 1989
• 17 Lamberts H, Brouwer H, Groen ASM, Huisman H. Het transitiemodel in de huisartspraktijk. Huisarts en Wetenschap 1987; 30: 105-13 (in Dutch).
• 18 Lisdonk vdEH, Bosch vdWJHM, Huygen FJA, Lagro-Janssen ALM. Ziekten in de Huisartspraktijk. Urtrecht: Bunge; 1990. (in Dutch).
• 19 Aitken RCB. Measurement of feelings using visual analogue scales. Proc R Soc Med 1969; 62: 989-6.
• 20 Reiser SJ. The decline of the clinical dialogue. J Med Philos 1978; 03: 305-13.
• 21 Quaak MJ, Westerman RF, van Bemmel JH. Comparisons between written and computerised patient histories. Brit Med J 1987; 295: 184-90.
• 22 Eisenberg JM, Williams SV, Garner L. et al. Computer-based audit to detect and correct overutilization of laboratory tests. Med Care 1977; 15: 915-21.
• 23 Stilwell JA, Young D, Cunnington A. Evaluation of laboratory tests in hospitals. Ann Clin Biochem 1980; 17: 281-6.
• 24 Zieve L. Misinterpretations and abuse of laboratory tests by clinicians. Ann NY Acad Sci 1966; 134: 563-72.