PATIENTS HEALTH AS A PREDICTOR OF PHYSICIAN AND PATIENT BEHAVIOR IN MEDICAL VISITS - A SYNTHESIS OF 4 STUDIES

OBJECTIVES. Although some patient characteristics are known to be rela ted to physician and patient communication in medical encounters, very little is known about the impact of patients' health status on commun ication processes. The authors assess relations of patients' physical and emotional health status to verbal and nonverbal communication betw een physicians and patients in four original studies, and combine resu lts across the four studies using meta-analytic procedures. METHODS. I n four original studies of routine outpatient visits (consisting of mo re than 250 physicians and more than 1,300 patients), health status wa s measured and audiotape or videotape records were coded for verbal co ntent and nonverbal cues indicating task-related behavior and affectiv e reactions on the part of both the physician and the patient. Both ph ysical and mental health data were obtained, using physicians and/or p atients 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 (b y sample size) average partial correlations, the combined P across stu dies (Stouffer method), and the test of effect size heterogeneity. RES ULTS. Physicians showed signs of negative response to sicker or more e motionally distressed patients, both in their behavior and in their ra tings of satisfaction with the visit. Sicker patients also behaved mor e negatively than healthier patients. However, physicians also engaged in a variety of positive and professionally appropriate behaviors wit h the sicker or more distressed patients. This mixed pattern of respon ses is discussed in terms of alternative frameworks: the physician's g oals, reciprocation of affect, and ambivalence on the part of the phys ician. CONCLUSIONS. The patient's health status appears to influence p hysician-patient communication. In clinical practice, increased attent ion by physicians to their own and their patients' behavior may enhanc e diagnosis and prevent misunderstandings.