Physicians’ Reactions to Patients Taking a Position: Sequence Analysis of Admission Interviews in Orthopedic Rehabilitation

ABSTRACT

Little is known about how patients influence health care providers’ communication behavior, although this knowledge may contribute to the understanding of the reciprocal influence of patient and provider communication and the pathways between communication and health care outcomes. Therefore, the aim of this study was to explore patients’ active communication behaviors and how this affects the immediate communication behavior of physicians. We coded 27 admission interviews from three German orthopedic rehabilitation centers with an adapted version of the Roter Interaction Analysis System. The data were analyzed using correlations and sequence analysis, specifically lag analysis. In this article, we report findings in relation to patients taking a position and physicians’ reactions. The analysis showed that while all patients took up a position during their consultation, they very rarely contradicted the physician. Moreover, many instances of patients’ expression of opinion were strongly determined by physicians’ behavior. When physicians asked patients for their opinions they often used alternative questions or closed questions that limited patients’ answering possibilities. While the lag analyses showed that patient communication behavior can influence physician communication, in the majority of instances patients’ expression of opinions did not lead to a discussion or shared decision making.

Acknowledgments

We thank the participating patients and cooperating rehabilitation centers for their support in the data collection.

Funding

The study was conducted in the project “Communication competencies of the chronically ill with regard to the interaction with treatment providers,” which is funded in Germany by the Federal Ministry of Education and Research (grant 01GX1042) as part of the funding priority for “Chronic Illnesses and Patient Orientation” (www.forschung-patientenorientierung.de).

Notes

¹ According to the formula with N being the amount of sequences of patient behavior followed by a physician behavior, the effect sizes are w = 0.6327 (Lag 1), w = 0.4537 (Lag 2), w = 0.3937 (Lag 3), and w = 0.3222 (Lag 4). Commonly 0.1 is interpreted as small, 0.3 as medium, and 0.5 as large effect size.

Additional information

Funding

The study was conducted in the project “Communication competencies of the chronically ill with regard to the interaction with treatment providers,” which is funded in Germany by the Federal Ministry of Education and Research (grant 01GX1042) as part of the funding priority for “Chronic Illnesses and Patient Orientation” (www.forschung-patientenorientierung.de).