Hahn Steven R, Bradt Pamela, Hewett Kathleen A, Ng Daniel B
Albert Einstein College of Medicine, Bronx, New York, United States of America.
Jacobi Medical Center, Bronx, New York, United States of America.
PLoS One. 2017 Nov 15;12(11):e0186122. doi: 10.1371/journal.pone.0186122. eCollection 2017.
Overactive bladder (OAB) and urinary incontinence are common problems that have significant impact on quality of life (QOL). Less than half of sufferers seek help from their physicians; many who do are dissatisfied with treatment and their physicians' understanding of their problems. Little is known about the sociolinguistic characteristics of physician-patient communication about OAB in community practice.
An IRB-approved observational sociolinguistic study of dialogues between patients with OAB and treating physicians was conducted. Study design included semi-structured post-visit interviews, post-visit questionnaires, and follow-up phone calls. Conversations were analyzed using techniques from interactional sociolinguistics.
Communication was physician- rather than patient-centered. Physicians spoke the majority of words and 83% of questions were closed-ended. The impact of OAB on QOL and concerns about and adherence to treatment were infrequently addressed by physicians, who were poorly aligned with patients in their understanding. These topics were addressed more frequently when open-ended questions successfully eliciting elaborated responses were used in ask-tell-ask or ask-tell sequences.
Clinical dialogue around OAB is physician-centered; topics critical to managing OAB are infrequently and inadequately addressed. The use of patient-centered communication is correlated with more discussion of critical topics, and thus, more effective management of OAB.
膀胱过度活动症（OAB）和尿失禁是常见问题，对生活质量（QOL）有重大影响。不到一半的患者会向医生寻求帮助；许多寻求帮助的患者对治疗以及医生对其问题的理解并不满意。在社区医疗实践中，关于膀胱过度活动症医患沟通的社会语言学特征鲜为人知。
开展了一项经机构审查委员会批准的关于膀胱过度活动症患者与主治医生对话的观察性社会语言学研究。研究设计包括访后半结构化访谈、访后问卷调查以及随访电话。对话采用互动社会语言学技术进行分析。
沟通以医生而非患者为中心。医生说了大部分的话，且83%的问题为封闭式问题。医生很少提及膀胱过度活动症对生活质量的影响以及对治疗的担忧和依从性，他们在理解上与患者的契合度很低。当在“询问 - 告知 - 询问”或“询问 - 告知”序列中使用能成功引出详细回答的开放式问题时，这些话题被提及得更频繁。
围绕膀胱过度活动症的临床对话以医生为中心；对管理膀胱过度活动症至关重要的话题很少被提及且讨论不充分。使用以患者为中心的沟通方式与对关键话题的更多讨论相关，因此能更有效地管理膀胱过度活动症。
