Flocke Susan A, Miller William L, Crabtree Benjamin F
Department of Family Medicine, Case Western Reserve University, Cleveland, Ohio, USA.
J Fam Pract. 2002 Oct;51(10):835-40.
Style of physician-patient interaction has been shown to have an impact on patient outcomes. Although many different interaction styles have been proposed, few have been empirically tested. This study was conducted to empirically derive physician interaction styles and to explore the association of style with patient reports of specific attributes of primary care, satisfaction with care received, and duration of the visit.
A cross-sectional observational study.
We observed 2881 patients visiting 138 family physicians for outpatient care in 84 community family practice offices in northeast Ohio.
Components of Primary Care Instrument (CPCI), patient satisfaction, and duration of the visit.
A cluster analysis of variables derived from qualitative field notes identified 4 physician interaction styles: person focused, biopsychosocial, biomedical, and high physician control. Physicians with the person-focused style rated highest on 4 of 5 measures of the quality of the physician-patient relationship and patient satisfaction. In contrast, physicians with the high-control style were lowest or next to lowest on the outcomes. Physicians with a person-focused style granted the longest visits, while high-control physicians held the shortest visits-a difference of 2 minutes per visit on average. The associations were not explained away by patient and physician age and gender.
In community-based practices, we found that the person-focused interaction style appears to be the most congruent with patient reported quality of primary care. Further investigation is needed to identify ways to support and encourage person-focused approaches and the time needed to provide such care.
医患互动方式已被证明会对患者的治疗结果产生影响。尽管已经提出了许多不同的互动方式，但很少有经过实证检验的。本研究旨在通过实证得出医生的互动方式，并探讨这种方式与患者对初级保健特定属性的报告、对所接受治疗的满意度以及就诊时长之间的关联。
一项横断面观察性研究。
我们观察了俄亥俄州东北部84个社区家庭诊所中，前往138位家庭医生处接受门诊治疗的2881名患者。
初级保健工具组件（CPCI）、患者满意度和就诊时长。
对来自定性实地记录的变量进行聚类分析，确定了4种医生互动方式：以人为本、生物心理社会、生物医学和医生高度控制型。以人为本的医生在医患关系质量和患者满意度的5项指标中的4项上得分最高。相比之下，高度控制型医生在这些结果上得分最低或接近最低。以人为本的医生就诊时间最长，而高度控制型医生就诊时间最短——平均每次就诊相差2分钟。患者和医生的年龄及性别并不能解释这些关联。
在社区医疗实践中，我们发现以人为本的互动方式似乎与患者报告的初级保健质量最为契合。需要进一步调查，以确定支持和鼓励以人为本方法的方式以及提供此类护理所需的时间。
