MEDICAL INTERVIEWING BY EXEMPLARY FAMILY PHYSICIANS

BACKGROUND. Little is known about the extent to which models of ideal physician-patient interviews are actually practiced by physicians. Thi s study examined physician-patient communication during medical interv iews by exemplary family physicians. METHODS. We performed a cross-sec tional study of verbal exchanges using 300 transcripts of office visit s made to two groups of family physicians: 9 exemplars and 20 controls . The exemplars were family physicians with fellowship training in fam ily therapy; the control group consisted of a convenience sample of bo ard-certified family physicians with no special training in communicat ion skills or counseling. Data were collected from June 1995 to July 1 996. Physician statements were rated according to the Level of Physici an Involvement model, which measures physicians' abilities to collabor ate with patients and address the psychosocial concerns of patients an d their families. Patient satisfaction ratings were obtained by a rese arch assistant immediately after the visit. RESULTS. Compared with the control physicians, the exemplars showed higher levels of psychosocia l involvement with patients during routine office visits. in particula r they involved patients more in the medical interview, offered more e motional support, and showed more family involvement. Despite this gre ater depth of Involvement, the length of office visits did not differ between the two physician groups. CONCLUSIONS. Our findings show that exemplars were more involved with their patients and provided more fam ily-oriented care than community physicians. Exemplars routinely appli ed a biopsychosocial approach, collaborating with patients and address ing psychosocial topics without sacrificing efficiency, while communit y physicians focused on biomedical issues.