Street Richard L, Gordon Howard, Haidet Paul
Department of Communication, Texas A&M University, TAMU 4234, College Station, TX 77843-4234, USA.
Soc Sci Med. 2007 Aug;65(3):586-98. doi: 10.1016/j.socscimed.2007.03.036. Epub 2007 Apr 25.
Although physicians' communication style and perceptions affect outcomes, few studies have examined how these perceptions relate to the way physicians communicate with patients. Moreover, while any number of factors may affect the communication process, few studies have analyzed these effects collectively in order to identify the most powerful influences on physician communication and perceptions. Adopting an ecological approach, this investigation examined: (a) the relationships of physicians' patient-centered communication (informative, supportive, partnership-building) and affect (positive, contentious) on their perceptions of the patient, and (b) the degree to which communication and perceptions were affected by the physicians' characteristics, patients' demographic characteristics, physician-patient concordance, and the patient's communication. Physicians (N=29) and patients (N=207) from 10 outpatient settings in the United States participated in the study. From audio-recordings of these visits, coders rated the physicians' communication and affect as well as the patients' participation and affect. Doctors were more patient-centered with patients they perceived as better communicators, more satisfied, and more likely to adhere. Physicians displayed more patient-centered communication and more favorably perceived patients who expressed positive affect, were more involved, and who were less contentious. Physicians were more contentious with black patients, whom they also perceived as less effective communicators and less satisfied. Finally, physicians who reported a patient-centered orientation to the doctor-patient relationship also were more patient-centered in their communication. The results suggest that reciprocity and mutual influence have a strong effect on these interactions in that more positive (or negative) communication from one participant leads to similar responses from the other. Physicians' encounters with black patients revealed communicative difficulties that may lower quality of care for these patients.
尽管医生的沟通风格和认知会影响治疗结果，但很少有研究探讨这些认知与医生和患者沟通方式之间的关系。此外，虽然有许多因素可能影响沟通过程，但很少有研究对这些影响进行综合分析，以确定对医生沟通和认知最具影响力的因素。本研究采用生态学方法，考察了：(a)医生以患者为中心的沟通（提供信息、给予支持、建立伙伴关系）和情感（积极、有争议）与他们对患者认知之间的关系；(b)沟通和认知受医生特征、患者人口统计学特征、医患一致性以及患者沟通影响的程度。来自美国10个门诊机构的29名医生和207名患者参与了该研究。编码人员根据这些就诊的录音，对医生的沟通和情感以及患者的参与度和情感进行评分。医生对他们认为沟通能力更强、更满意且更有可能遵医嘱的患者更以患者为中心。医生对表达积极情感、参与度更高且争议性较小的患者表现出更以患者为中心的沟通方式，对这些患者的认知也更积极。医生与黑人患者的争议性更大，他们还认为黑人患者沟通效果较差且满意度较低。最后，报告以患者为中心的医患关系取向的医生在沟通中也更以患者为中心。结果表明，互惠和相互影响对这些互动有很大影响，因为一方更积极（或消极）的沟通会导致另一方类似的反应。医生与黑人患者的交流中存在沟通困难，这可能会降低这些患者的护理质量。
