Henbest R J, Stewart M A
Department of Family Medicine, Medical University of Southern Africa.
Fam Pract. 1989 Dec;6(4):249-53. doi: 10.1093/fampra/6.4.249.
This paper presents a method for assessing the doctor-patient interaction in terms of its patient-centredness. Patient-centredness was defined in terms of doctor responses which enabled patients to express all of their reasons for coming, including symptoms, thoughts, feelings and expectations. The method was tested and found to be valid (correlations for criterion validity rs = 0.51 and 0.89), reliable (inter-rater correlation rs = 0.91, intra-rater correlation rs = 0.88), and sensitive, in that it was able to detect differences among doctors (P less than 0.001) and among doctor responses to different patient offers (P less than 0.001). The method was also found to be practical in that it was inexpensive and could be used for a variety of purposes such as by tutors to give feedback to their students, by examiners as part of the evaluation of candidates' consultation skills, and by students and clinicians alike, for self-assessment. The finding that the score for the first two minutes of the consultation correlated highly with the score for the entire consultation (rs = 0.806) greatly increases the time effectiveness of the method, suggesting that it would be practical for use on a large scale, including student assessment and future studies of the relationship between patient-centredness and patient outcomes.
本文提出了一种从以患者为中心的角度评估医患互动的方法。以患者为中心是根据医生的回应来定义的，这些回应能使患者表达出前来就诊的所有原因，包括症状、想法、感受和期望。该方法经过测试，发现具有有效性（效标效度的相关系数rs = 0.51和0.89）、可靠性（评分者间相关系数rs = 0.91，评分者内相关系数rs = 0.88），并且具有敏感性，因为它能够检测出医生之间的差异（P小于0.001）以及医生对不同患者陈述的回应之间的差异（P小于0.001）。该方法还被发现具有实用性，因为它成本低廉，可用于多种目的，例如导师向学生提供反馈、考官作为评估考生问诊技巧的一部分、学生和临床医生进行自我评估等。咨询开始两分钟的得分与整个咨询的得分高度相关（rs = 0.806）这一发现大大提高了该方法的时间效率，表明它在大规模应用中具有实用性，包括学生评估以及未来关于以患者为中心与患者治疗结果之间关系的研究。
