Beliefs About Control in the Physician-patient Relationship

Effect on Communication in Medical Encounters

Authors

  • Richard L. Street Jr. PhD,

    Corresponding author
    1. Received from the Department of Communication (RLS), Texas A&M University, College Station, Tex; Department of Psychology, Health Psychology Program (EK), Massachusetts College of Pharmacy and Health Sciences, Boston, Mass; Department of Communication (RAB), and Department of Medicine and UC Davis Center for Health Services Research in Primary Care (RLK), University of California–Davis, Davis, Calif; and Department of Medicine, The Houston Center for Quality of Care and Utilization Studies at the Houston Veterans Affairs Medical Center and Baylor College of Medicine (PH), Houston, Tex.
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  • Edward Krupat PhD,

    1. Received from the Department of Communication (RLS), Texas A&M University, College Station, Tex; Department of Psychology, Health Psychology Program (EK), Massachusetts College of Pharmacy and Health Sciences, Boston, Mass; Department of Communication (RAB), and Department of Medicine and UC Davis Center for Health Services Research in Primary Care (RLK), University of California–Davis, Davis, Calif; and Department of Medicine, The Houston Center for Quality of Care and Utilization Studies at the Houston Veterans Affairs Medical Center and Baylor College of Medicine (PH), Houston, Tex.
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  • Robert A. Bell PhD,

    1. Received from the Department of Communication (RLS), Texas A&M University, College Station, Tex; Department of Psychology, Health Psychology Program (EK), Massachusetts College of Pharmacy and Health Sciences, Boston, Mass; Department of Communication (RAB), and Department of Medicine and UC Davis Center for Health Services Research in Primary Care (RLK), University of California–Davis, Davis, Calif; and Department of Medicine, The Houston Center for Quality of Care and Utilization Studies at the Houston Veterans Affairs Medical Center and Baylor College of Medicine (PH), Houston, Tex.
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  • Richard L. Kravitz MD, MSPH,

    1. Received from the Department of Communication (RLS), Texas A&M University, College Station, Tex; Department of Psychology, Health Psychology Program (EK), Massachusetts College of Pharmacy and Health Sciences, Boston, Mass; Department of Communication (RAB), and Department of Medicine and UC Davis Center for Health Services Research in Primary Care (RLK), University of California–Davis, Davis, Calif; and Department of Medicine, The Houston Center for Quality of Care and Utilization Studies at the Houston Veterans Affairs Medical Center and Baylor College of Medicine (PH), Houston, Tex.
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  • Paul Haidet MD, MPH

    1. Received from the Department of Communication (RLS), Texas A&M University, College Station, Tex; Department of Psychology, Health Psychology Program (EK), Massachusetts College of Pharmacy and Health Sciences, Boston, Mass; Department of Communication (RAB), and Department of Medicine and UC Davis Center for Health Services Research in Primary Care (RLK), University of California–Davis, Davis, Calif; and Department of Medicine, The Houston Center for Quality of Care and Utilization Studies at the Houston Veterans Affairs Medical Center and Baylor College of Medicine (PH), Houston, Tex.
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Address correspondence and requests for reprints to Dr. Street: Department of Communication, TAMU 4234, Texas A&M University, College Station, TX 77843-4234 (e-mail: r-street@tamu.edu).

Abstract

OBJECTIVES: Effective communication is a critical component of quality health care, and to improve it we must understand its dynamics. This investigation examined the extent to which physicians' and patients' preferences for control in their relationship (e.g., shared control vs doctor control) were related to their communications styles and adaptations (i.e., how they responded to the communication of the other participant).

DESIGN: Stratified case-controlled study.

PATIENTS/PARTICIPANTS: Twenty family medicine and internal medicine physicians and 135 patients.

MEASUREMENTS: Based on scores from the Patient-Practitioner Orientation Scale, 10 patient-centered physicians (5 male, 5 female) and 10 doctor-centered physicians (5 male, 5 female) each interacted with 5 to 8 patients, roughly half of whom preferred shared control and the other half of whom were oriented toward doctor control. Audiotapes of 135 consultations were coded for behaviors indicative of physician partnership building and active patient participation.

MAIN RESULTS: Patients who preferred shared control were more active participants (i.e., expressed more opinions, concerns, and questions) than were patients oriented toward doctor control. Physicians' beliefs about control were not related to their use of partnership building. However, physicians did use more partnership building with male patients. Not only were active patient participation and physician partnership building mutually predictive of each other, but also approximately 14% of patient participation was prompted by physician partnership building and 33% of physician partnership building was in response to active patient participation.

CONCLUSIONS: Communication in medical encounters is influenced by the physician's and patient's beliefs about control in their relationship as well as by one another's behavior. The relationship between physicians' partnership building and active patient participation is one of mutual influence such that increases in one often lead to increases in the other.

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