Roter D L, Hall J A
Department of Health Policy and Management, Johns Hopkins School of Hygiene and Public Health, Baltimore, MD 21205.
Health Educ Res. 1991 Jun;6(2):185-93. doi: 10.1093/her/6.2.185.
Although the medical visit is widely acknowledged as an important event presenting unique opportunities for the modification of health beliefs and behaviors, health education theory has provided few explanatory mechanisms for understanding its communication process. The purpose of this paper is to explore a theoretical model loosely derived from social exchange and reciprocity theory for viewing the dynamics and consequences of patient-provider interaction during the medical encounter. We have elaborated this notion of reciprocity to suggest that provider behaviors within both the technical and socioemotional realm inspire parallel patient behaviors. For instance, a physician who is very informative may expect a patient to remember his instructions and comply with his recommendations. Further, a physician who is warm and friendly will inspire parallel patient attitudes in the socioemotional domain, such as friendliness and satisfaction. However, we believe that the reciprocity principle is only partially operative between domains. While an informative physician may be perceived as concerned and caring, merely being nice or caring, in the absence of indications of task performance (such as information giving), does not supply the evidence on competence that patients need to decide to attend to information or adhere to a therapeutic regimen. Our theory of reciprocal exchange in the medical visit is consistent with a consumerist perspective of patient-provider relations and with the activated patient philosophy of health education.
尽管就诊被广泛认为是一个重要事件，为改变健康观念和行为提供了独特机会，但健康教育理论几乎没有提供理解其沟通过程的解释机制。本文的目的是探索一个理论模型，该模型大致源于社会交换和互惠理论，用于观察医疗过程中患者与提供者互动的动态过程及后果。我们对互惠概念进行了阐述，认为技术和社会情感领域内提供者的行为会引发患者的相应行为。例如，一位提供大量信息的医生可能期望患者记住他的指示并遵守他的建议。此外，一位热情友好的医生会在社会情感领域引发患者类似的态度，如友好和满意。然而，我们认为互惠原则在不同领域之间只是部分起作用。虽然提供大量信息的医生可能被视为关心体贴，但仅仅友善或体贴，在没有任务表现迹象（如提供信息）的情况下，无法提供患者决定关注信息或坚持治疗方案所需的能力证据。我们关于就诊中互惠交换的理论与患者 - 提供者关系的消费主义观点以及健康教育的积极患者理念相一致。
