Systematic analysis of clinician-patient interactions: a critique of recent approaches with suggestions for future research.

Clinician-patient interactions are an important, but poorly understood, feature of our personal health care system. Attributes of these interactions have been shown to affect the health care process and appear as well to be amenable to change, furnishing a rationale for their study. Communications theory provides useful guidelines for systematic analysis. Systems of interaction analysis should take account of information transfer occurring on different levels through a variety of behaviors, incorporate interaction context and sequence into categorization schemes, deal with the unique characteristics of clinical encounters, and lend themselves to clinical teaching. Application of these guidelines to three representative systems (Bales' Interaction Process Analysis, Stiles' Verbal Response Modes, and Katz's Resource Exchange Analysis) illustrates diverse strengths and weaknesses. Future research on clinician-patient interactions should include the development of new analysis systems, a broader research time frame, increased emphasis on antecedents of interactions, and implementation of controlled trials.