Hall J A, Roter D L, Milburn M A, Daltroy L H
Department of Psychology, Northeastern University, Boston, MA, USA.
Med Care. 1996 Dec;34(12):1205-18. doi: 10.1097/00005650-199612000-00006.
Although some patient characteristics are known to be related to physician and patient communication in medical encounters, very little is known about the impact of patients' health status on communication processes. The authors assess relations of patients' physical and emotional health status to verbal and nonverbal communication between physicians and patients in four original studies, and combine results across the four studies using meta-analytic procedures.
In four original studies of routine outpatient visits (consisting of more than 250 physicians and more than 1,300 patients), health status was measured and audiotape or videotape records were coded for verbal content and nonverbal cues indicating task-related behavior and affective reactions on the part of both the physician and the patient. Both physical and mental health data were obtained, using physicians and/or patients as sources; in two studies, physicians' satisfaction with the visit also was measured. All available background characteristics for both physicians and patients were controlled via partial correlations. The meta-analytic procedures used were the unweighted and weighted (by sample size) average partial correlations, the combined P across studies (Stouffer method), and the test of effect size heterogeneity.
Physicians showed signs of negative response to sicker or more emotionally distressed patients, both in their behavior and in their ratings of satisfaction with the visit. Sicker patients also behaved more negatively than healthier patients. However, physicians also engaged in a variety of positive and professionally appropriate behaviors with the sicker or more distressed patients. This mixed pattern of responses is discussed in terms of alternative frameworks: the physician's goals, reciprocation of affect, and ambivalence on the part of the physician.
The patient's health status appears to influence physician-patient communication. In clinical practice, increased attention by physicians to their own and their patients' behavior may enhance diagnosis and prevent misunderstandings.
虽然已知一些患者特征与医疗问诊中医生和患者的沟通有关，但对于患者健康状况对沟通过程的影响却知之甚少。作者在四项原创研究中评估了患者的身体和情绪健康状况与医生和患者之间言语和非言语沟通的关系，并使用荟萃分析程序综合了四项研究的结果。
在四项关于常规门诊就诊的原创研究中（涉及250多名医生和1300多名患者），测量了健康状况，并对录音带或录像带记录进行编码，以获取言语内容以及表明医生和患者双方与任务相关行为和情感反应的非言语线索。通过医生和/或患者作为信息来源获取了身体和心理健康数据；在两项研究中，还测量了医生对就诊的满意度。通过偏相关控制了医生和患者所有可用的背景特征。所使用的荟萃分析程序包括未加权和加权（按样本量）平均偏相关、跨研究的联合P值（斯托弗方法）以及效应大小异质性检验。
医生在行为和对就诊满意度的评分方面，均表现出对病情较重或情绪困扰较大患者的负面反应迹象。病情较重的患者行为也比健康患者更消极。然而，医生也会对病情较重或困扰较大的患者采取各种积极且符合专业规范的行为。根据不同的框架讨论了这种混合反应模式：医生的目标、情感的 reciprocation以及医生的矛盾心理。
患者的健康状况似乎会影响医患沟通。在临床实践中，医生更多地关注自身和患者的行为可能会提高诊断效果并避免误解。
