Roter D L, Hall J A, Katz N R
Department of Behavioral Sciences and Health Education, Johns Hopkins School of Hygiene and Public Health, Baltimore, MD 21205.
Med Care. 1987 May;25(5):437-51. doi: 10.1097/00005650-198705000-00007.
This paper investigates associations between physicians' task-oriented and socioemotional behaviors, on the one hand, and analogue patients' satisfaction, recall of information, and global impressions. The study is based on role-playing subjects' responses to interactions between physicians and simulated patients. Audiotapes of two standardized patient cases presented by trained patient simulators to 43 primary care physicians were rated by role-playing patients (N = 258), and electronically filtered excerpts from the encounters were rated for vocal affect by 37 independent judges. Content analysis was made of the visits' transcripts to assess interaction process and to identify all medical information communicated. Finally, speech error rate was calculated from a combination of audiotape and transcript. Findings revealed that role-playing patients clearly distinguished task from socioemotional behaviors of the physicians, and a consistent pattern of association emerged between physicians' task behaviors and role-playing patients' satisfaction, recall, and impressions. Within the task domain, patient-centered skills (i.e., giving information and counseling) were consistently related to patient effects in a positive direction, but physician-centered behaviors (i.e., giving directions and asking questions) demonstrated the opposite relationship. A negative pattern of association was also evident between physicians' socioemotional behaviors and patient effects.
本文一方面研究医生的任务导向行为和社会情感行为与模拟患者的满意度、信息回忆及整体印象之间的关联。该研究基于角色扮演受试者对医生与模拟患者之间互动的反应。由经过培训的患者模拟者向43名初级保健医生呈现的两个标准化患者案例的录音带，由角色扮演患者（N = 258）进行评分，并且37名独立评判员对互动过程中经过电子筛选的片段的语音情感进行评分。对就诊记录进行内容分析，以评估互动过程并识别所有传达的医疗信息。最后，根据录音带和记录的组合计算言语错误率。研究结果显示，角色扮演患者能够清楚地区分医生的任务行为和社会情感行为，并且医生的任务行为与角色扮演患者的满意度、回忆及印象之间出现了一致的关联模式。在任务领域内，以患者为中心的技能（即提供信息和咨询）始终与患者的效果呈正相关，但以医生为中心的行为（即给出指示和提问）则呈现相反的关系。医生的社会情感行为与患者效果之间也明显呈现出负相关模式。
