PERPETUATING PASSIVITY - RELIANCE AND RECIPROCAL DETERMINISM IN PHYSICIAN-PATIENT INTERACTION

This study introduces, profiles, and tests the explanatory value of re liance, a construct that emerged from, and is expected to illuminate, consideration of perceived control in medical encounters. The investig ation also links communication science with the truly interactive pers pective of reciprocal determinism, highlighting the impact of personal relations and the significance of perceived control. Data from 271 en counters between general practitioners and patients in Oxford (England ) were collected by means of videotapes, patient questionnaires, medic al record reviews, and physician questionnaires. The analysis indicate s that physician-reliant patients (i.e., those who rely on physicians to make decisions for them) tend to be older and from a more working-c lass background than were self-reliant patients (i.e., those more inte rested in participating in choices about their health care). The physi cian-reliant patients also had more externally oriented outcome expect ations and tended to see physicians more often than did their self-rel iant counterparts. In addition to defining reliance at the conceptual and operational levels, this study provides preliminary evidence that reciprocal determinism is operating in medical encounters: Despite the ir preference for patients who feel in control of their health, physic ians fended to adapt to patients' reliance orientation, sharing decisi ons with self-reliant patients and making decisions for physician-reli ant patients. Accommodating the passive orientation of physician-relia nt patients is likely to diminish patients' chances for maintaining ce ntral in the medical encounter, which has implications for health outc omes, cost, and compliance.