Arthur Safiya A, Geiser Hanah R, Arriola Kimberly R Jacob, Kripalani Sunil
Emory University, Atlanta, Georgia, USA.
J Natl Med Assoc. 2009 Jul;101(7):677-83. doi: 10.1016/s0027-9684(15)30976-7.
Physician-patient communication can be described according to 4 prototypes of control--paternalism, mutuality, consumerism, or default. Patients with inadequate health literacy skills may be less-active participants in their care and more likely to have paternalistic encounters.
Two independent coders analyzed 31 transcribed outpatient medical visits between physicians and African American patients with diabetes according to the 4 prototypes of control. Differences in communication and the balance of power by level of patients' health literacy were analyzed by quantitative and qualitative methods.
Fourteen patients (45%) had inadequate health literacy, and most of them (N=8, 57%) had paternalistic encounters. Among patients with marginal or adequate health literacy skills, only 4 (23%) had paternalistic visits (p = .06), and encounters marked by mutuality were most common (N= 9, 53%).
Patients with inadequate health literacy appear more likely to have paternalistic interactions with their physicians.
医患沟通可根据四种控制模式来描述——家长式、相互式、消费主义式或默认式。健康素养技能不足的患者在其医疗护理中可能参与度较低，且更有可能经历家长式的医患交流。
两名独立编码员根据四种控制模式分析了31段医生与患有糖尿病的非裔美国患者之间门诊医疗问诊的转录记录。通过定量和定性方法分析了沟通差异以及患者健康素养水平对权力平衡的影响。
14名患者（45%）健康素养不足，其中大多数（N = 8，57%）经历了家长式的医患交流。在健康素养处于边缘或充足水平的患者中，只有4名（23%）经历了家长式问诊（p = 0.06），以相互式为特征的交流最为常见（N = 9，53%）。
健康素养不足的患者似乎更有可能与医生进行家长式互动。
