Roter Debra L
Bloomberg School of Public Health, Johns Hopkins University, 624 N. Broadway, Baltimore, MD 21205, USA.
Patient Educ Couns. 2003 May;50(1):17-21. doi: 10.1016/s0738-3991(03)00074-0.
Reviews of medically related communication research clearly demonstrate that physicians have been studied far longer and more frequently than any other type of health care provider; nevertheless, much of what is known is limited to what is said by primarily male, White, primary care physicians during the delivery of outpatient care. Furthermore, the majority of communication studies assess medical communication largely as a physician monologue with only occasional attention to what an individual patient may say back. Limitations of the literature are obvious. Little is known about the role of a patient companion during medical visits or the consequence of patient and provider race and gender concordance (or discordance) on interpersonal dynamics. We do not know very much about relationships under stress or how patients and providers respond in those rare, but critically important events when observational techniques in the natural setting are logistically impossible or otherwise inappropriate. While it is difficult to argue with the basic tenets of ecological validity and the value of authentic settings for observational studies, the contribution of simulations and analogue studies to our understanding of medical dynamics is worthy of consideration. This essay explores methodological and design challenges related to broadening the study of medical communication through more creative and thoughtful study designs.
对医学相关沟通研究的综述清楚地表明，与其他任何类型的医疗保健提供者相比，对医生的研究时间更长、频率更高；然而，目前已知的很多内容仅限于主要由白人男性初级保健医生在提供门诊护理时所说的话。此外，大多数沟通研究在很大程度上把医学沟通评估为医生的独白，只是偶尔关注患者可能的回应。文献的局限性显而易见。对于患者陪同人员在就诊过程中的作用，或者患者与医护人员的种族和性别一致性（或不一致性）对人际互动的影响，我们知之甚少。我们对压力下的关系了解不多，也不清楚在自然环境中的观察技术在逻辑上不可能或在其他方面不合适的那些罕见但至关重要的事件中，患者和医护人员是如何做出反应的。虽然很难反驳生态效度的基本原理以及真实环境对观察性研究的价值，但模拟研究和类似研究对我们理解医学动态的贡献值得考虑。本文探讨了与通过更具创造性和深思熟虑的研究设计来拓宽医学沟通研究相关的方法和设计挑战。
