Stewart M A
Soc Sci Med. 1984;19(2):167-75. doi: 10.1016/0277-9536(84)90284-3.
The discipline of family medicine has espoused a patient-centred model of the doctor-patient interaction. Patient-centred interactions are those in which the patient's point of view is actively sought by the physician. This implies that the physician behaves in a manner that facilitates the patient's expressing himself and that, for his part, the patient speaks openly and asks questions. The present exploratory study was undertaken to assess whether patient-centred interviews are related to positive outcomes. The study was conducted in 24 family physicians' offices where 140 doctor-patient interactions were audiotaped. Patients with both acute and chronic illnesses were included. The taped interactions were analysed using Bales Interaction Process Analysis. Ten days after the audiotaped visit the patients were interviewed in their home in order to assess their satisfaction with care, their reported compliance and to conduct a pill count. Bivariate analysis indicated that interviews in which physicians demonstrated a high frequency of patient-centred behaviour were related to significantly higher reported compliance and close to significantly better pill counts and satisfaction. Furthermore, in most instances, when the patient and physician scores were considered in combination, there was evidence that the physician's behaviour, particularly that sort of behaviour which initiated a discussion such as an explicit request for the patient's opinion, had more impact upon outcome than did the patient behaviour. The study suggests the importance in the setting of family practice of a patient-centred approach, one which is similar to models such as the negotiated approach to patienthood, described by psychiatrists.(ABSTRACT TRUNCATED AT 250 WORDS)
家庭医学学科一直支持以患者为中心的医患互动模式。以患者为中心的互动是指医生积极探寻患者观点的互动。这意味着医生的行为方式应便于患者表达自己，而患者也要坦诚发言并提问。本探索性研究旨在评估以患者为中心的问诊是否与积极结果相关。该研究在24个家庭医生诊所进行，共录制了140次医患互动。纳入了患有急性和慢性疾病的患者。使用贝尔斯互动过程分析方法对录制的互动进行分析。在录音问诊十天后，对患者进行家访，以评估他们对治疗的满意度、报告的依从性，并进行药片计数。双变量分析表明，医生表现出高频率以患者为中心行为的问诊与报告的依从性显著更高、药片计数近乎显著更好以及满意度更高相关。此外，在大多数情况下，综合考虑患者和医生的得分时，有证据表明医生的行为，特别是那种引发讨论的行为，如明确征求患者意见，对结果的影响比患者行为更大。该研究表明在家庭医疗环境中采用以患者为中心方法的重要性，这种方法类似于精神科医生所描述的如协商患者身份的模式。（摘要截选至250字）
