Shaw Jane R, Adams Cindy L, Bonnett Brenda N, Larson Susan, Roter Debra L
Department of Population Medicine, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada.
J Am Vet Med Assoc. 2008 Nov 15;233(10):1576-86. doi: 10.2460/javma.233.10.1576.
To compare the clinical interview process, content of the medical dialog, and emotional tone of the veterinarian-client-patient interaction during wellness appointments and appointments related to a health problem in companion animal practice.
Cross-sectional descriptive study.
A random sample of 50 companion animal practitioners in southern Ontario and a convenience sample of 300 clients and their pets.
For each practitioner, 6 clinical appointments (3 wellness appointments and 3 problem appointments) were videotaped. The Roter interaction analysis system was used to analyze the resulting 300 videotapes.
Wellness appointments were characterized by a broad discussion of topics, with 50% of data-gathering statements and 27% of client education statements related to the pet's lifestyle activities and social interactions. Wellness appointments included twice as much verbal interaction with the pet as did problem appointments, and the emotional atmosphere of wellness appointments was generally relaxed. There were more social talk, laughter, statements of reassurance, and compliments directed toward the client and pet. In contrast, during problem appointments, 90% of the data gathering and client education focused on biomedical topics. Coders rated veterinarians as hurried during 30 of the 150 (20%) problem appointments; they rated clients as anxious during 39 (26%) problem appointments and as emotionally distressed during 21 (14%).
Results suggested that veterinarian-client-patient communication differed between wellness and problem appointments. Owing to the emphasis on biomedical content during problem appointments, veterinarians may neglect lifestyle and social concerns that could impact patient management and outcomes, such as client satisfaction and adherence to veterinarian recommendations.
比较伴侣动物诊疗中健康检查预约和与健康问题相关预约期间兽医-客户-宠物互动的临床问诊过程、医疗对话内容及情感基调。
横断面描述性研究。
安大略省南部50名伴侣动物从业者的随机样本以及300名客户及其宠物的便利样本。
为每位从业者的6次临床预约（3次健康检查预约和3次问题相关预约）进行录像。使用罗特尔互动分析系统对由此产生的300份录像带进行分析。
健康检查预约的特点是对话题进行广泛讨论，50%的数据收集陈述和27%的客户教育陈述与宠物的生活方式活动和社交互动有关。健康检查预约中与宠物的言语互动是问题相关预约的两倍，且健康检查预约的情感氛围通常较为轻松。有更多的社交谈话、笑声、安慰性陈述以及针对客户和宠物的赞美。相比之下，在问题相关预约期间，90%的数据收集和客户教育集中在生物医学主题上。编码人员在150次问题相关预约中的30次（20%）中认为兽医匆忙；他们在39次（26%）问题相关预约中认为客户焦虑，在21次（14%）中认为客户情绪困扰。
结果表明，健康检查预约和问题相关预约之间兽医-客户-宠物的沟通存在差异。由于在问题相关预约中强调生物医学内容，兽医可能会忽视可能影响患者管理和结果的生活方式及社会问题，如客户满意度和对兽医建议的依从性。
