LEVELS OF PHYSICIAN INVOLVEMENT WITH PATIENTS AND THEIR FAMILIES - A MODEL FOR TEACHING AND RESEARCH

Background. We present an educational model that describes physician s kills for addressing psychosocial concerns of patients, ranging from b asic medical questions to in-depth psychotherapy. This model improves upon previously published models by integrating into one hierarchy lev els of physician involvement with individual patients and levels of in volvement with families. Methods. Ten faculty family physicians were v ideotaped during 200 office visits. Interviews were categorized accord ing to the model, with a 79% interrater agreement. Results. Most visit s involved the lower three levels of physician involvement (41%, level 1; 35.5%, level 2; and 23%, level 3). Discussion of family context oc curred in a majority (58.5%) of visits, primarily when another family member was in the room and during preventive care visits. Higher level s were associated with longer visits-about 3 minutes more for each add itional level. Conclusions. This investigation suggests that the level s of physician involvement model can be reliably measured. This model may be a useful tool for education and research, particularly the stud y of physician interview skills appropriate to family medicine.