COMMUNICATION PATTERNS OF PRIMARY-CARE PHYSICIANS

Objectives.-To use audiotape analysis to describe communication patter ns in primary care, to relate these to ideal relationship types as des cribed in the literature, and to explore the patterns' relationships w ith physician and patient characteristics and satisfaction. Design.-De scription of routine communication in primary care based on audiotape analysis and patient and physician exit questionnaires. Setting.-A tot al of 11 ambulatory clinics and private practices. Participants.-The p articipants were 127 physicians and 537 patients coping with ongoing p roblems related to disease. Main Outcomes Measures.-Roter Interactiona l Analysis System (RIAS) and patient and physician exit satisfaction q uestionnaires. Results.-Cluster analysis revealed 5 distinct communica tion patterns: (1) ''narrowly biomedical,'' characterized by closed-en ded medical questions and biomedical talk occurring in 32% of visits; (2) ''expanded biomedical,'' like the restricted pattern but with mode rate levels of psychosocial discussion occurring in 33% of the visits; (3) ''biopsychosocial,'' reflecting a balance of psychosocial and bio medical topics (20% of the visits); (4) ''psychosocial,'' characterize d by psychosocial exchange (8% of visits), and (5) ''consumerist,'' ch aracterized primarily by patient questions and physician information g iving (8% of visits). Biomedically focused visits were used more often with more sick, older, and lower income patients by younger, male phy sicians. Physician satisfaction was lowest in the narrowly biomedical pattern and highest in the consumerist pattern, while patient satisfac tion was highest in the psychosocial pattern. Conclusions.-Primary car e communication patterns range from narrowly biomedical to consumerist patterns and parallel the ideal forms of patient-physician relationsh ips described in the literature.