Analyzing patient participation in medical encounters

An essential component of the delivery of health care is the consultation b etween the patient and health care provider. Participation in the medical c onsultation is fundamentally a communicative event in which clinicians and patients use talk to exchange information, to share their expertise and poi nts of view, to build a trusting relationship, and to make health-related d ecisions. A growing body of evidence indicates that patients who more activ ely participate in these encounters are more satisfied with their health ca re, receive more patient-centered care (e.g., information, support) from pr oviders, are more committed to treatment regimens, have a stronger sense of control over health, and even experience better health following the visit than do more passive patients (for reviews, see Kaplan, Greenfield, & Ware , 1989; Roter & Hall, 1993; Street, 2001). Because patient involvement is a n important part of the health care process, it is imperative that investig ators analyze the phenomenon using reliable and valid measures that have a solid conceptual foundation. In this article, we have three objectives. First, we describe the conceptua l foundation and measurement strategies used in our approach to analyzing t he communicative acts that constitute patient participation in medical enco unters. Second, we apply our method to an analysis of nine videotaped recor dings of physician-patient interactions. Two research questions (RQs) will be examined: (a) To what extent do patients ask questions, express concerns , and engage in assertive behavior in their interactions with physicians? a nd (b) Are patients more active communicators when their physicians use par tnership building (e.g., soliciting the patient's opinion) and supportive t alk (e.g., reassurance, encouragement)? Finally, we conclude with a discuss ion of challenges and prospects for developing more ecologically valid and efficient procedures for assessing patient participation in care.